Differential Diagnosis of Bone Metastasis and Intervertebral Disc Herniation

Bone metastasis and intervertebral disc herniation are two completely different diseases, differing in etiology, clinical manifestations, diagnostic methods, and treatment approaches.

1. Etiology: Bone metastasis results from malignant tumors originating outside the bone tissue spreading to the bone via the bloodstream. In contrast, intervertebral disc herniation is caused by degenerative changes in the lumbar intervertebral discs, rupture of the annulus fibrosus, and protrusion of the nucleus pulposus, which compresses the nerve roots or spinal cord.

2. Clinical Manifestations: The main symptom of bone metastasis is persistent bone pain that worsens at night, possibly accompanied by systemic symptoms such as pathological fractures, hypercalcemia, and anemia. Intervertebral disc herniation typically presents as low back pain radiating to the buttocks, posterior thigh, calf, and even the foot. Pain worsens with coughing or sneezing, and severe cases may involve muscle weakness and sensory abnormalities.

3. Diagnostic Methods: Diagnosis of bone metastasis primarily relies on imaging studies such as X-ray, CT, MRI, and bone scans, combined with blood tests and pathological biopsy. Accurate diagnosis of intervertebral disc herniation depends on detailed medical history, physical examination, and imaging studies, particularly MRI, which clearly shows the severity and location of the disc herniation and its impact on the nerve roots.

4. Treatment: Bone metastasis is mainly treated with comprehensive approaches such as chemotherapy and radiotherapy, while intervertebral disc herniation is commonly managed with nonsurgical treatments such as physical therapy and medication. Surgical treatment may be considered in severe cases.