Often wrong diagnostics herniated disc or ISG syndrome?

Likelihood of confusion with consequences: disc herniation and ISG syndrome differ
Every fifth medical intervention on the intervertebral discs is unnecessary, according to experts. Because the strong back pain that drives patients to the doctor, often come not from the spine, but from the so-called sacroiliac joint, short ISG. This ligament connects the spine to the pelvic bone. If he shifts even minimally, intense symptoms arise which often give riddles to physicians.

"Pain at this interface radiate partly to the buttocks, the back thigh along to the knee and thus resemble the symptoms of a herniated disc. Distinguishing both syndromes is difficult even for experts. With the right kind of diagnosis, however, confusion can be ruled out and false therapies can be prevented, "explains Dr. med. med. Markus Donat, neurosurgeon from the spine center at Stiglmaierplatz in Munich.

A herniated disc in the lumbar spine is usually associated with massive pain. (Image: Henrie / fotolia.com)

Classify symptoms correctly
To make initial assumptions about the pain causes, there are two clues for laymen. For one thing, numb, sleepy legs point to a herniated disc. This is because escaping tissue presses on the underlying nerve cords, causing neurological deficits and numbness. In contrast, they do not occur in an ISG syndrome. On the other hand, pain on the sacroiliac joint - unlike the large-scale complaints of a herniated disc - can be precisely located.

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

More accurate diagnosis at the doctor
In case of a concrete suspicion of one of the two illnesses, sufferers should always consult an expert. This already draws first conclusions from a detailed anamnesis. For example, suspected causes provide information about the nature of the disease: Falls on the buttocks often trigger an ISG blockage, whereas the common causes of herniated discs include excessive strain or lack of exercise. To more accurately determine spine problems, imaging techniques such as computed tomography and magnetic resonance imaging are helpful. On top of this, experts recognize whether the gelatinous tissue presses on the nerve cords. Blockages in the iliosacral region, however, can not usually be visualized. For this reason, physicians resort to so-called provocation tests. A more familiar form of these types of controls is the compression test.

While the person is in a lateral position, the doctor exerts pressure on the pelvis with both hands. If this leads to the triggering of the typical pain in the ISG area, this suggests an ISG syndrome.

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

In the case of a herniated disc, the irritated nerve swells. If it is an inflammation of the sacroiliac joint, the process inhibits the origin of the stimulus and relieves the symptoms. In pronounced forms of ISG blockade, experts today resort to so-called iFuse implants. In contrast to conventional screw systems, the specially coated implants give the joint new hold and grow into the surrounding bone within three to six weeks. Health insurance companies take over the costs in full. (sb, pm)