[The differential diagnosis of lumbar disk prolapse]

When examining a patient with a radicular syndrome the first step is to localize the neurologic damage. Clinical examination usually allows differentiation of radicular from plexus and peripheral nerve lesions and also from non-neurogenic symptoms. The second step is to look for etiology, which often needs additional investigations. Plain films of the spine with views in flexion and extension show disease of the bony structures and instability. Soft tissue alterations leading to radicular or dural compression are best shown by computed tomography, which is also the method of choice to prove space occupying lesions of the abdominal and pelvic cavity. Myelography shows best longitudinal extension of intraspinal processes. Magnetic resonance imaging is the method of choice to prove intramedullary lesions. Early diagnosis of spine infection needs scintigraphy. Radicular inflammation or irritation by tumor-cells (meningosis) will be missed with-out CSF-examination.