[Preoperative precise diagnosis and surgical treatment outcomes in patients with atypical low back and leg pain]

Atypical low back and leg pain represents a diagnostic and therapeutic challenge in spinal-related disorders. This study aims to explore the underlying causes of atypical low back and leg pain in patients whose imaging findings do not correspond to clinical symptoms and signs, and to evaluate the accuracy of preoperative diagnosis methods and the effectiveness of minimally invasive surgical treatment.

A retrospective analysis was conducted on the clinical data of 174 patients with atypical low back and leg pain, characterized by inconsistencies between symptoms, physical signs, and imaging findings, who were treated in the Department of Spine Surgery and Orthopaedics of Xiangya Hospital between May 2016 and May 2023. Comprehensive imaging evaluation, literature review, selective nerve root block, and discography were utilized preoperatively to achieve precise diagnosis and segment localization. Patients underwent spinal endoscopic discectomy. Paired-sample t-tests were used to compare Visual Analogue Scale (VAS) pain scores and Oswestry disability index (ODI) scores before surgery, at 1 month postoperatively, and at final follow-up.

The mean age of the 174 patients was (47.2±7.9) years; 76 were male and 98 female. The cohort included 29 patients with discordance between the side of lumbar disc herniation on imaging and symptomatic side, 46 with imaging severity inconsistent with symptom severity, 23 with mismatch between imaging lesion level and neurologic localization signs, and 76 with multilevel lumbar degeneration complicating localization. The follow-up duration ranged from 4 to 28 (13.3±6.7) months. Paired-sample t-test results showed significant improvements in VAS pain scores and ODI at 1 month postoperatively and at final follow-up compared with baseline (P<0.001).

Management of atypical low back and leg pain caused by lumbar degenerative disease requires an integrated physical signs, and imaging findings. Employing multiple methods for preoperative precision diagnosis and localization is essential to achieve optimal surgical outcomes.