Lower Extremity Arterial Occlusive Disease

Differential Diagnosis Strategy between Lower Extremity Arterial Occlusive Disease and Lumbar Disc Herniation

Goal of the Study?

In this study, 1 the aim is to understand the risk factors and symptoms that contribute to patients with Lower Extremity Arterial Occlusive Disease (LEAOD) being misdiagnosed with lumbar disc herniation (LDH).


Why are they doing this study?

The authors argue that patients who should be diagnosed with lower extremity arterial occlusive disease are being diagnosed with LDH as there are similar symptoms. They argue it is important to understand what factors contribute to this misdiagnosis so that there is no delay in treatment and an increased economic burden to patients and society.


What was done?

This was a clinical study with a total of 148 patients. Group A had 126 patients who had LDH with lower extremity symptoms and whose symptoms had been relieved after lumbar surgery of posterior lumbar interbody fusion (PLIF). Group B had 22 patients with LDH with lower extremity symptoms but who had no relief after PLIF. In this group, they were diagnosed with LEOAD and their symptoms recovered after vascular treatment. The Japanese Orthopedic Association and Oswestry disability index scores were collected before surgery, six months after PLIF and sex months after vascular treatment. An evaluation of symptom relief between patients in groups A and B was then used. For each group, the researchers also collected gender, age, HBP, diabetes, smoking, coronary, pulse pressure (PP), LDH, segment and type, ankle-brachial index (ABI) and straight leg raising test (SLRT). They then used statistical software to determine the relationship between the various factors.


What did they find?

They found a statistical difference between the two groups in PP, ABI, central disc herniation and SLRT. The researchers found that higher PP, lower ABI, central disc herniation and negative SLRT led to an increased risk of misdiagnosis for LDH, even though these are all associated with LEAOD. Moreover, they found patients were misdiagnosed as having LDH as a way to explain lower limb symptoms even though MRI images displayed only a mild herniation. The authors argue it is important to consider other imaging exams such as CTA and MRA and sufficient patient history and physical exam to determine a diagnosis for LEAOD.  For example, skin temperature and abnormal skin colour are common in patients with LEAOD, but not LDH.


Why do these findings matter?

 Appropriate diagnosis is key to appropriate and timely treatment. Understanding how to differentiate LEAOD from LDH is important for good patient care.