Some patients with disc herniation, when you ask for MRI and correlate it with patients symptoms and signs you may find no correlation between them e.g small size disc with severe pain
This eventual dissonance depends upont the localization and orientation of the herniated disc.For example, relatively small lateral disc prolapses may cause serious symptomatics and nerve damage because the intervertebral foramina are very narrow.
The type and intensity of pain not only depend on hernia´s size. Besides the position and size, is important to diagnose other degenerative diseases that can cause back pain, for example: facet arthrosis
The dimension of the spinal canal is very important, not only the displacement of the hernia. So if it is enough space into the spinal canal the herniated disc could be even asimptomatic
The most important thing is the size of the canal the size of the disc and the level of the herniation as well as the area the disc is protruding to. Central disc is a wide canal may be not as bad as a small side disc protruding to the foramina. Also small central disc in a narrow, due to degeneration, canal is symptomatic too. So all is down to, space, size and location.
If you do doubt the relationship of disc herniation and the symptoms and signs,then you doubt it. Because may be there are other reasons that caused the pain of legs or backs or anyother position of the back.
Yes, the diagnosis should be precisely done. Do not exclude a circumsripted engagement of small radicular vessels (beginning with acute pain, then followed by relief with neurologic deficit).
Disc disease is not the only cause of Back pain or better referred back pain to lower limbs (Sciatica). There are many factors influence this pain and is not only pressure. The possibility of spinal deformities have to be excluded (spondylolisthesis, spinal stenosis ect.). If there is no correlation of the size of the disc or the combined size, position of protrusion and dimensions of canal (the most common cause of sciatica) then alternative diagnosis may be considered. Any neurological deficit or condition and syndromes (neuro growths (primary - secondary), myelopathy, Gillain-Barre, Myopathy, diabetic neuropathy ect.). Osteoporosis may usually causing back pain can imitate sciatica too. On top of this piriformis syndrome or scaroilical joint disorders have to be excluded. Vascular problems of small arteries or even aorta (aortic aneurism) can be the cause of sciatic pain as well. Despite of all these conditions you have to exclude social-economics or compensation reasons that can "cause" sciatica. All the above may give you a better idea of the reasons that a patient with not proven by MRI cause of sciatica may still persist to have symptomatology.
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