Diabetic amyotrophy coexisting with lumbar disk herniation and stenosis: a case report.
BACKGROUND
Clinical differentiation of diabetic neuropathy from HLD or lumbar stenosis may be difficult. The issue of misdiagnosis has been discussed as a reason for poor outcome after lumbar spine surgery. The authors report a case of diabetic amyotrophy coexisting with, rather than misdiagnosis of, HLD or lumbar stenosis.


METHODS
This 68-year-old female diabetic patient had left sciatic pain for 3 months, and the pain was suddenly aggravated for the last 1 week. She underwent foraminotomy and diskectomy for herniated disk and stenosis at L4-5 level because of failure of conservative treatment, positive SLR test result, and radiologic evidence of disk herniation and stenosis without electrodiagnostic study or consideration of the possibility of diabetic neuropathy. Distal leg pain was resolved, but proximal thigh pain persisted after surgery. During 1 month after surgery, thigh pain got worse, and weakness of left leg developed. Electrodiagnostic study revealed diabetic amyotrophy. She was treated with a tricyclic antidepressant and an antiepileptic drug. Pain and weakness improved incompletely 8 months after medication.


CONCLUSIONS
Electrodiagnostic and radiologic studies should be used in every diabetic patient presenting with leg pain and/or weakness to differentiate diabetic neuropathy from HLD, lumbar stenosis, or other space-occupying lesion. Thorough history taking and neurologic examination are needed to differentiate between these diseases, and the possibility of coexistence of or overlapping with these diseases should be considered. When the 2 diseases coexist as pain sources, treatment of both diseases may be needed for relief of the patient's pain.
Cho
Keun-Tae
KT
Department of Neurosurgery, Dongguk University College of Medicine, Goyang, Korea. ktcho21@naver.com
Kim
Nam Hee
NH
D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D002420:Cauda Equina / Q000473:pathology; D019299:Decompression, Surgical; D003929:Diabetic Neuropathies / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D004568:Electrodiagnosis; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D007796:Laminectomy; D017843:Ligamentum Flavum / Q000473:pathology; D008159:Lumbar Vertebrae / Q000473:pathology; D008279:Magnetic Resonance Imaging; D011128:Polyradiculopathy / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D012008:Recurrence; D012584:Sciatic Nerve / Q000473:pathology / Q000503:physiopathology; D012585:Sciatica / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D013115:Spinal Canal / Q000473:pathology; D013130:Spinal Stenosis / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D017211:Treatment Failure
D000927:Anticonvulsants; D000929:Antidepressive Agents, Tricyclic