At present, most doctors and patients believe that “it is the herniated disc that compresses the nerve and produces the patient’s back and leg pain, and the greater the herniated disc the more severe the back and leg pain”. In the days when CT and MR imaging were not available, doctors and patients were convinced of this statement, and even more so with the availability of CT and MR imaging. Therefore, doctors and patients try every possible way to make the herniated discs disappear or shrink through various treatments to eliminate the clinical symptoms of patients. We also followed this theory to guide our work before carrying out CT-guided drug interventions. Xing Wenhua, Department of Cervical Spine Surgery, Second Affiliated Hospital of Inner Mongolia Medical University
But in the clinical practice work in the past twenty years, we found that there is a discrepancy between the fact and the theory. Due to the advantages and special features of our radiologists’ work, we receive dozens of patients who come for lumbar spine CT or MR examination because of low back pain every day. We have studied the correlation between the patients’ lumbar disc herniation and clinical low back pain symptoms and found that
1: Patients with herniated discs and clinical symptoms of low back and leg pain on CT or MR examination before surgery, although their clinical symptoms of low back and leg pain disappeared after surgery, the performance of imaging examination after surgery was the same, the herniated discs were still herniated and did not disappear because of surgery.
2: Some patients are bulging in the imaging examination, and they can have the same clinical symptoms of low back pain as the herniated disc, even though they do not see the herniated disc compressing the nerve.
3: Since we carried out CT-guided drug interventional therapy in 1993, many patients with herniated discs that most doctors think must be treated surgically (including severely herniated discs or with free discs) have had their clinical symptoms of low back and leg pain disappear through interventional therapy, but the patient’s discs are still found to exist in the imaging examination.
4: In some patients, the site of disc herniation shown by CT and MR imaging does not match the clinical symptoms of the patient; for example, the left side of the disc is herniated, but the radiating pain of the lower extremity is on the right side; or some patients have a herniated L5-S1 disc, but the clinical symptoms are caused by the L4-5 disc lesion.
Therefore, clinical practice tells us:
1: Patients with clinical symptoms of back and leg pain, imaging (CT, MR) can herniate discs!
2: imaging (CT,MR) with disc herniation, clinical symptoms of low back pain can be absent!
3: Imaging examination (CT,MR) with disc herniation. Patients with no clinical symptoms of low back and leg pain should not worry about the protruding disc and do not need any treatment!