Extraosseous spinal lesions mimicking disc disease.

To identify characteristics of patient presentation that would help distinguish extraosseous spinal tumors from the more common herniated disc, nine cases of intraspinal tumors were reviewed. These nine patients were identified in a group of 744 patients who presented with symptoms similar to disc herniation but failed to respond to conservative care and underwent spinal surgery. This study indicates that intraspinal tumor should be suspected in patients with the following characteristics: 1) painless neurological deficit; 2) night pain or pain which increases in the supine position; 3) pain disproportionate to that normally expected with lumbar disc disease; 4) no change in symptoms after successful surgery for herniated disc; 5) elevated spinal fluid protein; or 6) a teenager with symptoms of disc herniation. Myelography is an effective radiologic procedure for the diagnosis of spinal tumor but MRI should be equally effective if the procedure includes a scan of the conus as well as cauda equina.