International Journal of Medical Discoveries

This case describes a patient who was initially diagnosed In Spine Surgical Hospital as lumbar Disc Herniation (LDH) and planned for surgical intervention but was later found to have Multiple Sclerosis (MS) after further neurological evaluation. It highlights the importance of maintaining a high index of suspicion, repeating the neurological examination, and involving a multidisciplinary team in intractable lumbar disc cases, particularly before proceeding to surgery. It is well established that the earlier the diagnosis of MS the better is outcome with proper management on the long-term prognosis. In this patient, early labeling as a surgical case contributed to the failure to identify Lhermitte’s sign and pyramidal signs that may appear later. Further assessment, together with neurophysiological studies including Nerve Conduction Studies (NCS) and visual evoked potentials (VEP), supported central nervous system involvement and helped confirm MS while excluding lumbar disc herniation as the cause of the presentation. This case reflects a clinical challenge. In our experience, patients with central nervous system pathologies may be misidentified as surgical lumbar candidates when initial assessments are focused primarily on radicular symptoms, thus delaying the diagnosis of MS.