Some aspects of differential diagnosis of pain syndromes in discogenic neurocompression pathology

Abstract

Background. A lot of factors may cause development of failed back surgery syndrome after disc hernia (DH) excision. One of them is non-adequate preoperative choice with over-diagnosis or over-estimation of clinical value of discogenic neurocompression pathology (DNP). Neurosurgical intervention is poor effective or in-effective if combined with prevailing non-vertebral disorder or the DH is a mask of another pathology, concomitant silent MRI finding. The purpose of the study was to improve preoperative choice of DH patients due to improvement of differential diagnosis of discogenic neurocompression and other pathologies associated with cervicobrachial or low back or pelvic pain or pain syndrome in extremities. Materials and methods. According to data of the Background. A lot of factors may cause development of failed back surgery syndrome after disc hernia (DH) excision. One of them is non-adequate preoperative choice with over-diagnosis or over-estimation of clinical value of discogenic neurocompression pathology (DNP). Neurosurgical intervention is poor effective or in-effective if combined with prevailing non-vertebral disorder or the DH is a mask of another pathology, concomitant silent MRI finding. The purpose of the study was to improve preoperative choice of DH patients due to improvement of differential diagnosis of discogenic neurocompression and other pathologies associated with cervicobrachial or low back or pelvic pain or pain syndrome in extremities. Materials and methods. According to data of the Clinic of Minimally Invasive and Laser Spinal Neurosurgery of SI “Romodanov Neurosurgery Institute of NAMS of Ukraine” (2013–2015) just 35.3 % of DH patients consulted for persistent pain syndrome had DNP and required surgical intervention. The rest patients (674.7 %) did not undergo DH excision as other disorders caused pain. In this group of patients (4437) with clinically not significant DH the reasons for pain syndrome were assessed. Results. More than half patients were found to have musculo-tonic and myoscleromy syndromes (vertebrogenic reflector (secondary) and primary cervicobrachial or low back or pelvic enthesopathy and in extremities) causing pain and in 17 % patients pathology of extra-vertebral joints and nervous system inflammatory disorders (NSID). The authors represents the criteria for differential diagnosis of pain syndromes in DH and NSID. The etiologic factors of NSID were estimated by complex laboratory data. A clinical case of NSID in DH patient and algorithm for preoperative choice are considered. Conclusions. Diagnosis of DH as a reason for neurologic syndrome is verifying if clinical and neuroimaging data fall together.  The identified disruption of neurologic manifestation and MRI data  requires thorough examination to distinguish DH patients requiring surgical intervention and patients with silent DH concomitant to other disorders or prevailing non-vertebrogenic disease in a case of combined pathology.