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Journal of Korean Neurosurgical Society 2005;38(2): 144-146.
Multi-access for the Diagnosis of Missed Upper Lumbar Disc Herniation.
Dong Yeob Lee, Hyung Seok Kim, Sang Ho Lee
1Department of Neurosurgery, Gimpo Airport Wooridul Spine Hospital, Seoul, Korea. nsspine@paran.com
2Department of Radiology, Gimpo Airport Wooridul Spine Hospital, Seoul, Korea.
3Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea.
Herein, a case of missed upper lumbar disc herniation, diagnosed by thorough neurological examination, digital infrared thermographic imaging(DITI), and repeated magnetic resonance(MR) image study, is reported. A 36-year-old female presented with intractable leg pain on left anterior thigh. Although she underwent lumbar MR image at other hospital, she was misdiagnosed as acute sprain. Neurological examination suggested the possibility of upper lumbar disc herniation, which was confirmed by DITI, MRI, and selective root block. After operation, her leg pain was significantly improved. It should be considered that upper lumbar disc herniation might be misdiagnosed as an acute sprain, as in our case. A high index of suspicion based on thorough neurological examination is most important in such cases. Then, multi-access such as DITI, MR image, and selective block, base on thorough neurological examination, are warranted.
Key Words: Upper lumbar disc herniation; Neurologic examination; Digital infrared thermographic imaging(DITI)
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