Often wrong diagnoses: herniated disc or ISG syndrome?

Risk of confusion with consequences: differentiate herniated disc and ISG syndrome
Every fifth medical intervention on the intervertebral discs is unnecessary, according to experts. Because the severe back pain that drives patients to the doctor often does not come from the spine, but from the so-called sacroiliac joint, ISG for short. This ligamentous apparatus connects the spine to the pelvic bone. If it shifts even minimally, there are intense complaints that often puzzle doctors.

“Pain at this transition point radiates to the buttocks, along the rear thigh to the knee, and is therefore similar to the symptoms of a herniated disc. Distinguishing both clinical pictures is difficult even for experts. With the right type of diagnosis, however, mistakes can be excluded and wrong therapies prevented, ”explains Dr. med. Markus Donat, neurosurgeon from the spine center at Stiglmaierplatz in Munich.

Classify symptoms correctly
There are two clues for laypeople to make initial conjectures about the causes of pain. On the one hand, numb legs that have fallen asleep indicate a herniated disc. This is because emerging tissue presses on the nerve strands behind it, which triggers neurological failures such as feelings of numbness. However, these do not occur in ISG syndrome. On the other hand, pain on the sacroiliac joint can be precisely localized - quite differently from the large-scale complaints of a herniated disc.

"Often those affected can point to the point of origin of the complaint to the left or right of the lumbar spine," explains the expert.

More precise diagnosis at the doctor
If there is a specific suspicion of one of the two diseases, the victim should always consult an expert. This draws first conclusions from a detailed medical history. Presumed causes provide information about the type of illness: falls on the buttocks often trigger an ISG blockade, but the frequent reasons for herniated discs include excessive stress or lack of exercise. Imaging methods such as computer and magnetic resonance imaging help to determine problems in the spine more precisely. Experts use these to recognize whether the gelatinous tissue is pressing on the nerve strands. Blockages in the sacroiliac area can usually not be depicted. For this reason, doctors resort to so-called provocation tests. A more well-known form of these types of controls is the compression test.

While the patient is lying on their side, the doctor puts pressure on the pelvis with both hands. If the typical pain in the ISG area is triggered, this suggests an ISG syndrome.

Treat correctly
If conservative methods such as physiotherapy for herniated discs or ISG syndromes do not lead to the desired result, doctors often use so-called infiltration therapy. Here, experts apply a mixture of a locally acting anesthetic and an anti-inflammatory drug directly to the appropriate location using a small needle.

In the event of a herniated disc, the irritated nerve swells. If there is inflammation of the sacroiliac joint, the procedure inhibits the origin of the stimulus and provides relief from the symptoms. For pronounced forms of ISG blockage, experts today use so-called iFuse implants. In contrast to conventional screw systems, the specially coated implants give the joint new support and grow together with the surrounding bones within three to six weeks. Health insurance companies cover the full costs. (sb, pm)

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