Can MS Be Mistaken for a Herniated Disc?

Unraveling the Diagnostic Dilemma: MS vs. Herniated Disc

When persistent pain, numbness, or weakness strikes, patients often find themselves trapped in a labyrinth of medical uncertainty. Multiple sclerosis (MS) and herniated discs share a frustratingly similar symptom profile, creating a diagnostic challenge that can leave patients and healthcare providers searching for definitive answers. This complexity underscores the critical importance of comprehensive medical evaluation and advanced diagnostic techniques. In this article, you will learn about the intricacies of both conditions, their similarities and differences, and why misdiagnosis can occur. 

What Is Multiple Sclerosis?

Multiple sclerosis is an autoimmune disease that affects the central nervous system (CNS), which includes the brain and spinal cord. In MS, the immune system mistakenly attacks the protective covering of nerve fibers, called myelin, leading to inflammation and scarring. This damage disrupts the normal transmission of nerve signals, resulting in a wide range of symptoms.

What Is a Herniated Disc?

A herniated disc, also known as a slipped disc or ruptured disc, occurs when the soft inner core of an intervertebral disc pushes through the tough outer layer. This can happen in any part of the spine but is most common in the lower back (lumbar spine) and neck (cervical spine). Herniated discs can put pressure on nearby nerves, causing pain and other symptoms.

What Are Some Similarities in Symptoms?

One of the primary reasons MS can be mistaken for a herniated disc is the overlap in symptoms. Both conditions can cause:

• Pain - Both MS and herniated discs can lead to various types of pain, including back pain, neck pain, and radicular pain (pain that radiates along the nerve path).
• Numbness and tingling - Paresthesia, or the sensation of numbness and tingling, is common in both conditions.
• Weakness - Muscle weakness can occur in both MS and herniated disc cases, particularly affecting the legs or arms.
• Spasticity - Both conditions can cause muscle stiffness and involuntary muscle contractions.

What Are the Key Differences?

Despite the similarities, there are several key differences between MS and herniated discs:

• Cause and progression

MS is an autoimmune disease caused by a combination of genetic, environmental, and immune system factors. It is a chronic, often progressive condition that can affect multiple areas of the CNS.

Herniated discs, on the other hand, are typically the result of age-related wear and tear or injury to the spine. They are localized to specific areas of the spine and may improve with time or treatment.

• Additional symptoms

MS can cause a wide range of symptoms beyond those shared with herniated discs, including:

• Visual disturbances
• Fatigue
• Cognitive changes
• Balance problems
• Bladder and bowel dysfunction

Herniated discs primarily cause symptoms related to the affected area of the spine and the nerves it impacts.

• Diagnostic methods

While both conditions may require MRI scans for diagnosis, the findings differ:

• MS diagnosis involves looking for characteristic lesions or plaques in the brain and spinal cord.
• Herniated disc diagnosis focuses on identifying the displaced disc material and its impact on surrounding structures.

How Can Misdiagnosis Occur?

Several factors contribute to the potential misdiagnosis of MS as a herniated disc or vice versa:

• Symptom overlap - As discussed, many symptoms are common to both conditions.
• Similar age of onset - Both MS and herniated discs often develop when people are in their 30s, making age less of a distinguishing factor.
• Coexistence of conditions - Some individuals may have both MS and herniated discs, complicating the diagnostic process.
• Limitations of imaging - In some cases, distinguishing between MS lesions and compressive myelopathy due to a herniated disc can be challenging on MRI.

Why Is Accurate Diagnosis So Important?

Obtaining an accurate diagnosis is crucial for several reasons:

• Treatment approach - MS and herniated discs require different treatment strategies. MS typically involves disease-modifying therapies and management of symptoms, while herniated discs may be treated with physical therapy, pain management, or, in some cases, back surgery.
• Prognosis - The long-term outlook and progression of these conditions differ significantly, affecting patient expectations and life planning.
• Avoiding unnecessary interventions - Misdiagnosing MS as a herniated disc could lead to unnecessary surgical procedures, while misdiagnosing a herniated disc as MS could result in inappropriate medication use.

What Is the Impact of Comorbidity?

It is important to note that some individuals may have both MS and herniated discs. This comorbidity can have significant implications:

• Increased disability - Studies have shown that MS patients with accompanying degenerative disc pathology may have worse disability scores.
• Compounded symptoms - The presence of both conditions can exacerbate symptoms and further complicate diagnosis and treatment.
• Quality of life - The combination of MS and herniated discs can have a more severe impact on a person’s overall quality of life compared to either condition alone.

What Diagnostic Approaches Are Used?

To differentiate between MS and herniated discs, healthcare providers may use a combination of methods:

• Comprehensive medical history - Understanding the onset, progression, and nature of symptoms is crucial.
• Neurological examination - This can help doctors identify specific deficits and their patterns.
• Imaging studies - MRI scans of the brain and spine are essential. For MS, these may show characteristic lesions, while for herniated discs, they can reveal the displaced disc material.
• Additional tests - For MS, cerebrospinal fluid analysis and evoked potential tests (which measure the electrical activity in areas of the brain and spinal cord) may be used to support the diagnosis.

What Are the Different Treatments for MS and Herniated Discs?

The treatment approaches for MS and herniated discs differ significantly:

• Multiple sclerosis treatment

• Disease-modifying therapies to reduce relapses and slow progression
• Symptom management medications
• Physical therapy and rehabilitation
• Lifestyle modifications

• Herniated disc treatment

• Conservative measures such as rest, physical therapy, and pain management
• Medications for pain relief
• In some cases, surgical intervention may be discussed and potentially recommended

While multiple sclerosis and herniated discs can present with similar symptoms, they are distinct conditions with different causes, progressions, and treatment approaches. The potential for misdiagnosis highlights the importance of thorough evaluation by healthcare professionals experienced in both neurological and spinal conditions.

If you are experiencing symptoms that could be attributed to either MS or a herniated disc, it is crucial to seek medical attention for an accurate diagnosis. Remember that in some cases, both conditions may coexist, further emphasizing the need for comprehensive evaluation and personalized treatment plans.

By understanding the similarities and differences between these conditions, patients and healthcare providers can work together to ensure accurate diagnosis and appropriate management, ultimately improving outcomes and quality of life for those affected by these challenging health issues.

If you have a herniated disc that is not responding to conservative treatment, a discectomy may be discussed and potentially recommended. Although this is generally a very successful procedure, having a large hole in the outer ring of the disc more than doubles the risk of needing another operation. A new treatment, Barricaid, is a bone-anchored device that closes this hole, and 95 percent of Barricaid patients did not undergo a reoperation due to reherniation in a 2-year study timeframe. This treatment is done immediately following the discectomy—during the same operation—and does not require any additional incisions or time in the hospital. 

If you have any questions about the Barricaid treatment, ask your doctor or contact us today.

For full benefit/risk information, please visit: https://www.barricaid.com/instructions.