Correlation of standard diagnostic studies with surgically proven lumbar disk rupture

One hundred patients with surgically proven ruptured lumbar disks were studied in terms of their diagnostic work-up. Four studies--electromyogram, CT scan, myelogram, and epidural venogram--were evaluated independently and in combination. No one study was consistently abnormal; however, epidural venography was diagnostic in 74% of cases. CT scanning and electromyographic examination, when used in combination, were found to be reliable in confirming the diagnosis of lumbar disk rupture in 84% of cases. In no instance were all preoperative diagnostic studies normal when a diagnosis of herniated nucleus pulposus was proven surgically. It seems, therefore, that a detailed history and physical examination in combination with a positive result in at least one of the diagnostic studies appears sufficient to establish the diagnosis of lumbar disk rupture.