Diabetic amyotrophy coexisting with lumbar disk herniation and stenosis: a case report

BackgroundClinical 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.Case DescriptionThis 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.ConclusionElectrodiagnostic 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.