Herniated Nucleus Pulposus Differential Diagnoses

Updated: May 20, 2019
  • Author: Deepak Gautam, MBBS, MS(Orth); Chief Editor: Jeffrey A Goldstein, MD  more...
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DDx

Diagnostic Considerations

The diagnosis of an internal disk derangement is controversial. The classic patient presents with back pain without imaging abnormalities except for varying degrees of the black disk, which is the converse of the asymptomatic patient with an intervertebral disk herniation.

Patients without a disk herniation have a favorable course and long-term outcome with conservative treatment or surgery. However, some patients with prolonged limitations and limited job skills benefit from surgical intervention for segmental instability or clinical instability. A positive diskogram, if properly done and carefully interpreted in context, may raise the expectation of success for surgical treatment in this patient population.

The greatest controversy is over the effectiveness of fusion surgery. Unfortunately, there is no clear objective criterion; clinical judgment is mandatory and is not perfect; clearly, good patients do well, and patient selection is paramount.

Differential Diagnoses