If pain occurs in the area of the lower back, the medical history and clinical examination are particularly important for the correct diagnosis of lumboischialgia. The exact description of the pain is particularly important. Above all, the onset of the pain, the degree of pain and other symptoms must be described precisely.
If the pain first occurred during heavy lifting work, this indicates pain due to a herniated disc in the lumbar spine. If the pain increases slowly or has been present for a long time, this may be an indication of an inflammatory or tumorous origin. If the pain radiates into the legs, or other symptoms such as paralysis, sensation or incontinence occur, this is a clear indication of a nervous cause in the area of the spinal canal and requires rapid clarification and, if necessary, rapid surgical treatment.
In addition, the previous medical history serves as an orientation for lumboischialgia. In case of a previously known tumor disease, bone metastases are possible. If a herniated disc in the area of the lumbar spine has already occurred earlier, there is a greater risk of a new herniated disc.
As part of the clinical examination of lumboischialgia, the back is examined for muscular tension or pressure pain. This would indicate a muscular problem and does not require surgical treatment. Furthermore, neurological examinations serve to find out more precisely the diagnosis of lumboischialgia.
The leg reflexes in particular are checked. If the partellas tendon reflex (PSR) or the Achilles tendon reflex (ASR) fails, there is a suspicion of a herniated disc with compression and thus failure of the nerve in question. Differences in sensitivity in the legs and buttocks are also indicative of a nerve injury.
A clinical test for lumboischialgia is the positive Lasègue sign. Here the patient is laid flat on his back and then the stretched leg is bent passively by the examiner in the hip joint. If the patient suffers back pain during flexion of <70°, which suddenly shoots up and radiates into the leg in question, the test is positive.
In this case it is a clear indication of a herniated disc in the lumbar spine of the segments L4/5 and L5/S1. Laboratory chemistry can also provide clues to a possible cause. Very high inflammation parameters are an indication of an inflammatory process in the body and may possibly be related to back pain.
Changes in the blood count in combination with weight loss and pain can indicate a malignant process. If meningitis or cancer cells in the cerebrospinal fluid are suspected, a cerebrospinal fluid puncture is performed. This also reveals corresponding cells which may be the cause of the back pain.
However, tumorous or inflammatory causes are rather rare in suddenly occurring back pain. For this reason, imaging diagnostics of the lumbar spine plays a very important role in addition to the medical history. The ultrasound examination (sonography) is used to assess the soft tissues and can reveal inflammation, edema (water retention), an abscess or changes in the musculature.
If these changes are visible, a herniated disc may be ruled out. However, the ultrasound examination for diagnosis is only suitable in exceptional cases. In order to detect bony changes such as an osteophyte or a fracture, an X-ray is helpful.
This allows a relatively good assessment of the bony spine and can be performed quickly. However, magnetic resonance imaging of the lumbar spine (MRI) is the best examination method for exact examination and finding the cause. With this method, the soft tissues as well as the bones and spinal canal of the lumbar spine can be assessed.
In addition, the spinal canal of the lumbar spine can be visualized with the help of a contrast medium. This makes even the smallest constrictions of the spinal canal visible. (spinal canal stenosis of the lumbar spine) However, since the examination takes a relatively long time (approx.
30 min) and the patient must lie completely still and flat during this time, a computer tomogram (CT) is performed in acute cases. Although this means a relatively high radiation exposure for the patient, it allows a good view of the vertebral bodies and intervertebral discs. For this reason, a CT of the lumbar spine is always performed first in an emergency and for a quick diagnosis.
- Ultrasound
- X-ray image
- Computer tomography (CT) or
- Magnetic resonance imaging of the lumbar spine (MRT).
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