Reason Analysis Of Misdiagnosis Between Lumbar Disc Herniation And Sacral Tumor

Objective:To reduce the misdiagnosis and provide evidence for the early diagnosis of lumbardisc herniation and sacral tumors through reason analysis of misdiagnosis between lumbardisc herniation and sacral tumors.Methods:65sacral tumors cases of our department from2000to2010were revised and15cases were misdiagnosed as lumbar disc herniation. All the cases were specificallyanalyzed through the clinical data including gender, age, tumor location, characteristics,first visit clinical symptoms, X-ray, CT, and MR examination and then the reason ofmisdiagnosis were analyzed.Results:15cases of65patients were misdiagnosed (23.1%) including7males and8femalesaged from14to68years old (mean46years).11cases were high location sacral tumorsand4cases were low location.1case was misdiagnosed as L3~4disc herniation,8cases were misdiagnosed as L4/5disc herniation, and6cased were misdiagnosed as L5/S1herniation. There were3cases of trauma history.12cases have lumbosacral pain.3caseshad perineal pain and paralysis.3cases had bowel and bladder dysfunction.3cases had nosymptoms of the lower limbs pain (with symptoms of perineal pain, paralysis anddiscomfort).3cases had lower extremity pain and paralysis.9cases had unilateral limbpain and paralysis.8cases had pain and paralysis below the knee.4cases had thigh painand paralysis.10cases had lumbosacral tenderness (4cases had diffuse pain of lowerlimbs).6cases had perineal skin paralysis.11cases had lower extremity paralysis (4caseshad thigh paralysis.7cases had paralysis below the knee.4cases had perineal areaparalysis.15cases of patients with lumbar X-ray films showed no report of sacralanomaly.Sacrum area was not included as X-rays examination in4cases.1case of sacral1giant cell tumor had the evidence of sacral nerve root hole expanded.1case of sacral2chordoma had the evidence of soft tissue swelling shadows.1case of sacral1metastaseshad the evidence of reduced bone density near the ear-like surface like bone destruction.1case of sacral2giant cell tumor had the evidence of bulging of bone edges.11casesreceived CT scan and scan area were set at lumber3/4,4/5and lumbar/sacral1.(1casewas reported as L3/4disc herniaiton,4cases were reported as L4/5disc herniation,6cases were reported as L5/S1disc herniation). All the15cases received no MRexamination.Conclusion:1. Anatomy structure of lumbosacral bones and nerves was the main cause ofmisdiagnosis.2, Similarities and differences of pain induced by sacral tumors and lumbardisc herniation should be focused.3Lumbar disc herniation induced muscle weakness,sensory area of skin disorders and tendon reflexes change which has correspondingposition characteristics. Sacral tumors (according to different tumor characteristics anddisease area) induced clinical manifestations of the muscle weakness, sensory area of skindisorders and tendon reflex change which had no "Positioning characteristic."4, Imagingexamination was important way to identify lumbar disc herniation or sacral tumors.Lumbar disc herniation X-ray examination had evidence of disc height change, and early sacral tumor X-ray has no characteristic performance due to affect of abdominal organs.CT scans were often set as intervertebral space and sacrum bone structure scan wereignored. MR imaging examination become the early detection of lesions of lumbar sacraand was called "golden means” because it can showed the complete features of lumber andsacral bone.5. Compared with lumbar disc herniation, sacral tumor was rare disease,doctors should strengthen awareness of sacral tumor-related knowledge.