其他疾病误诊为腰椎间盘突出症临床分析

Clinical Analysis of Other Diseases Misdiagnosed as Prolapse of Lumbar Intervertebral Disc

目的分析其他疾病误诊为腰椎间盘突出症的原因,并总结防范误诊措施。方法回顾性分析2010年10月—2021年2月13例被误诊为腰椎间盘突出症的临床资料。结果本组首发症状为单纯腰痛者6例,腰痛伴下肢疼痛麻木者7例,初期均被误诊为腰椎间盘突出症,接受1种或多种非手术方法治疗,效果不佳。误诊时间为1周~15个月。经详细询问病史、严格查体并结合实验室、MRI、γ干扰素释放试验、骨髓穿刺涂片、术后病理等检查,最终明确诊断为多发性骨髓瘤、骨转移癌、非特异性脊椎感染、椎管内良性占位(脊髓室管膜瘤1例、椎管内表皮样囊肿1例、椎管内髓外脂肪瘤1例)各3例,脊柱结核1例。多发性骨髓瘤及骨转移癌患者经化疗、自体骨髓移植、靶向药物等治疗后,均在3年内死亡;非特异性脊椎感染患者经抗感染治疗后痊愈,脊柱结核患者抗结核治疗失败后手术,目前在康复中;椎管内良性占位患者均经手术治疗后痊愈。结论为避免其他复杂原因引发的腰腿疼痛疾病误诊为腰椎间盘突出症,应做到详细询问病史,严格查体,明确病位,重视实验室检查指标,及时行MRI检查,并提高临床医师鉴别诊断能力。

Objective To analyze causes of other diseases misdiagnosed as prolapse of lumbar intervertebral disc(PLID),and to summarize measures to prevent misdiagnosis.Methods Clinical data of 13 patients who had been misdiagnosed as having PLID between October 2010 and February 2021 was retrospectively analyzed.Results Among the 13 patients,initial symptom was simple low back pain in 6 patients,and initial symptom was low back pain associated by pain and numbness of lower limbs in 7 patients.All patients were misdiagnosed as having PLID initially.They received one or more kinds of non-surgical treatments,and the results were far from satisfactory.Misdiagnosed duration ranged from one week to 15 months.There were 3 patients with multiple myeloma,3 patients with metastatic carcinoma of bone,3 patients with nonspecific spinal infectious diseases,3 patients with benign intraspinal occupying lesion(1 with spinal ependymoma,1 with intraspinal epidermoid cyst,1 with intraspinal extramedullary lipoma)and 1 patient with spinal tuberculosis after detailed medical history,seriously physical examination and laboratory examinations,MRI,interferon-γ release assay(IGRA),bone marrow smear and postoperatively pathological examination.Patients with multiple myeloma and metastatic carcinoma of bone all died within 3 years after treatments such as chemotherapy,autologous bone marrow transplantation and targeted drugs.Patients with nonspecific spinal infectious diseases were already cured after anti-infective treatments.Patient with spinal tuberculosis underwent surgery and was recovering currently after failing anti-tuberculosis treatment.Patients with benign intraspinal occupying lesion had already been cured after surgery.Conclusion In order to avoid misdiagnosis of lumbar and leg pain due to other causes as PLID,clinicians should inquire case history carefully,conduct physical examination seriously,define the location of the disease accurately,pay attention to indicators of laboratory analysis,conduct MRI examination in time,and improve the ability of differential diagnosis.