Unusual Tumors Simulating Protrusion of the Intervertebral Disc

Abstract

In any of the various branches of medicine and surgery it is of basic importance to diagnose a given condition as accurately as possible. Very often a given lesion will produce characteristic signs and symptoms as with the protruded intervertebral disc in the production of low back pain with sciatic radiation. By the use of suitable diagnostic procedures, not the least of which is a careful history and physical examination, an intelligent therapeutic attack may be planned. Even though all reasonable possibilities have been considered, a presumably “simple problem” may be loaded with surprise. It is just as important to stress the necessity for avoiding the error of omission in the diagnostic effort as an error of commission in the therapeusis.

In recent years the syndrome of protruded intervertebral disc as a source of low back pain with sciatic radiation has aroused considerable interest. Because the history is often so typical and the physical findings so conclusive, it is almost inevitable that there should be a tendency to relax diagnostic vigilance. As this syndrome is encountered more frequently and as the surgeon's experience enlarges, it is easier to overlook the limitations of the general and special physical examinations, i.e., orthopedic and neurologic. This, however, is no more true of the protruded intervertebral disc syndrome than of any other. Each individual patient presents a particular problem in the choice of a diagnostic routine. Whether or not lumbar puncture or x-ray study, with or without an intraspinal contrast medium, should be made. . .