RESUMEN
A herniated disc is a condition in which the nucleus pulposus is displaced from the intervertebral space. It usually leads to back pain, thus being the most common reason for it. Patients often describe the first symptoms of a herniated disc as extreme and decisive pain. Unlike the usual mechanical back pain, a herniated disc is often related to a stinging or burning sensation that often spreads to the lower extremities and proves to be continuous at lower temperatures. We present a case of a 58-year-old male patient who visited the Acibadem City Clinic with complaints of pain initially starting from his hip, which in time extended to his left leg (L5 radiculopathy) and a few days later to his right leg (L5 radiculopathy). Before visiting the clinic, he had been treated in Germany with physiotherapy and supplements, which had proved ineffective. After an MRI, which revealed an L4-L5 herniated disc, he underwent conservative treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) and proton pump inhibitors (PPIs) for 14 days in addition to Medrol 4mg tablets (3x1 per day for 10 days). On the third day of the treatment, 60% of the symptoms had subsided. Seven months later, he came in for a scheduled checkup, and 95% of the symptoms were gone. A controlled MRI was done, and the herniated disc had completely vanished. We hope that this type of research will benefit medical professionals, patients, researchers, doctors, and students, among others. Such cases also contribute to the quality of care for such patients and help set regulated factual guidelines regarding their treatment as a whole.
RESUMEN
Disc herniation and hip-joint pathology may present with overlapping symptoms, complicating the diagnosis and treatment strategy in some cases. To ensure a correct diagnosis, this study emphasizes the need for imaging methods like MRI scans of the hip joints, complementary to the lumbar spine, when in doubt of coexisting hip pathology with symptomatic lumbar disc herniation. A typical complaint in clinical practice among patients with lumbar disc herniation is chronic back pain, often radiating down the legs. Although there could be considerable overlap in pain between hip joint issues and disc herniation, the etiology of these two conditions might differ. In these situations, a comprehensive diagnostic evaluation is crucial, as demonstrated by the three clinical case studies provided here. This article underscores the importance of conducting thorough imaging tests such as hip-joint and spine MRI scans to accurately differentiate among various disorders. Pathologies such as avascular necrosis can go unnoticed on X-rays of the hip joint, but an MRI scan provides a more precise diagnosis in these situations. The cases described here highlight the challenge of differentiating between hip-joint pathology and disc herniation due to their similar symptoms. For a diagnosis to be made quickly and accurately, modern imaging techniques must be used in conjunction with a comprehensive diagnostic approach and physical examination, which will improve patient outcomes and enable proper management.
RESUMEN
Spinal epidural hematoma is a rare clinical entity with an incidence of approximately one per 1,000,000 patients per year. Spinal epidural hematoma is a lesion that can cause spinal cord compression or cauda equina syndrome. We report a clinical case of а 69-year-old male patient who presented to the Neurosurgery Clinic of the General Hospital for Active Treatment "Dobrich" with pain and weakness in both legs for two months after falling in the bathroom. MRI revealed an L2-L3 fracture and a formation in the L2-L3 epidural space, which was compressing the nerve roots. An operative treatment was performed under general anesthesia and, intraoperatively, it was discovered that the formation was a hematoma. Aspiration of the hematoma and decompression of the spinal canal were performed. An L2-L3 stabilization with pedicle screws was done due to total laminectomy and potential instability. Postoperatively, the patient was mobilized on the day after intervention, and no surgery-related complications were observed. The patient experienced relief from his symptoms and was discharged on the fifth day. Six months post-surgery, the patient started to experience pain in his left leg. Radiography showed coxarthrosis on the left hip joint and the patient was referred to the orthopedics for further treatment.