Anatomical characteristics and surgical selections of upper lumbar disc herniation / 中国骨伤

<p><b>OBJECTIVE</b>To explore the anatomical characteristics and surgical selections of upper lumbar disc herniation, and evaluate its clinical effects.</p><p><b>METHODS</b>From January 2009 to January 2013, 26 patients with upper lumbar disc herniation were treated in our department. There were 16 males and 10 females, aged from 28 to 51 years old with an average of 45.7 years, 4 cases were in L₁,₂, 9 cases in L₂,₃, and 13 cases in L₃,₄. The data was collected including distance between outer edge of lower facet and the spinous process, the outer edge of the isthmus and spinous process, the lower edge of lamina and the upper edge of the intervertebral space, nerve root arising points and lower edge of the corresponding pedicle. Transforaminal discectomy and interbody fusion combined with pedicle screw fixation was performed in patients with L₁,₂, L₂,₃ herniated disk and 5 patients with L₃,₄ herniated disk complicated with lumbar instability. However another 8 patients with L₃,₄ herniated disk were treated with posterior fenestration decompression. Clinical effects were evaluated by Japanese Orthopaedic Association(JOA). The relative height rate(R) of the intervertebral space was measured preoperatively and 1 year postoperatively. The fusion of the bone graft was also observed.</p><p><b>RESULTS</b>Intraoperative anatomical measurement was taken in all patients. All patients were followed up for more than 1 year with an average of 16 months, and all incisions got healing, JOA was improved from preoperative(10.13±1.49) points to last follow up (25.21±2.13) points with the improvement rate of 79.9%. Among the patients underwent fusion operation, 17 cases obtained bone fusion and 1 case maybe non fusion and no internal fixation failure was found;the R value was (0.231±0.056) mm preoperatively, however (0.345±0.076) mm at 1 year after operation with statistical difference(<0.05). In the patient underwent posterior fenestration decompression, the R value was(0.243±0.036) mm preoperatively, and (0.212±0.046) mm at 1 year after operation without statistical difference (>0.05). No spinal instability and lumbar disc herniation recurrence were found in these patients.</p><p><b>CONCLUSIONS</b>According to the anatomical characteristics of L₁,₂ and L₃,₄ herniated disk, these patients could be treated with transforaminal discectomy and interbody fusion. The anatomical characteristics and clinical manifestations of L₃,₄ herniated disk is similar with the lower lumbar disc herniation, for the patients, an appropriate surgical method should be chosen according to the lumbar stability.</p>

Herniation of Upper Lumbar Disc: Clinical Finding & Surgical Result

STUDY DESIGN: A retrospective study. OBJECTIVES: We attempted to establish an efficient diagnosis and treatment modality by analyzing clinical manifestations and operative results of upper lumbar disc herniations. SUMMARY OF LITERATURE REVIEW: Upper lumbar disc herniations represented a lower incidence but have become easier to diagnose by predictable clinical aspects and an MRI scan. The operative results have been satisfactory. MATERIALS AND METHODS: We evaluated 41 cases, which were operated with posterior laminectomy and discectomy from September, 1996 to November, 2009. We analyzed pre-operative history, clinical and MRI findings, and then assessed operative results by Kim's criteria and functional change in the follow up. RESULTS: The prevalence of upper lumbar disc herniations in all disc herniations was 8.8%. Pre-operative manifestations were lower back pain (85.4%), radiating pain (80.5%), sensory deficit (53.7%), motor deficit (53.7%), and depressed knee jerk (65.9%). The positive rate of the femoral stretching test (78.0%) was higher than the straight leg raising test (39.0%). The VAS score changed from preoperative 9.0+/-0.8 into postoperative 1.4+/-1.3 points. The operative results were excellent or good in 82.9%. The rate of resuming previous work, including slight modification was 90.2%. CONCLUSIONS: Predictable clinical aspects of the upper lumbar disc herniations are anterior thigh pain with lower back pain, variable motor deficit, sensory deficit, depressed knee jerk and the positive femoral nerve stretching test. Through careful examination and radiological evaluations such as MRI, operative treatment can obtain a symptomatic improvement and satisfactory results.

Posterior lumbar interbody fusion in treatment of upper lumbar disc herniation / 中国矫形外科杂志

[Objective]To evaluate the effectiveness of posterior lumbar interbody fusion(PLIF) in the treatment of upper lumbar disc herniation.[Method]Twenty six patients of upper lumbar disc herniation underwent posterior lumbar interbody fusion,lumbago VAS and the pain in waist and lower extremities grades were tested before operation,all patients had an average follow-up period of 20.8 months,then lumbago VAS and the pain in waist and lower extremities grades were tested at last follow-up,lumbago VAS and the pain in waist and lower extremities grades were compared through paired t-test.[Result]All 26 patients had a followed-up.Postoperative VAS had significant lower than preoperative,statistical analysis has remarkable significance(P

Transforminal lumbar interbody fusion technique in treatment of upper lumbar intervertebral disc herniation / 中国矫形外科杂志

[Objective] To investigate the surgical method of transforminal lumbar interbody fusion(TLIF)technique in treatment of upper lumbar intervertebral disc herniation.[Methods]From January 2002 to December 2006,a retrospective analysis on TLIF surgery treatment of 45 patients with upper lumbar intervertebral disc herniation were carried out and they acquired 12~24 months(mean,15 months)follow up.There were 29 males,and 16 females aging from 30~55 years(mean,39.2 years).Eleven intervertebral spaces were T12-L1 hernination,25 intervertebral spaces were L1、2 hernination,and 18 intervertebral spaces were L2、3 hernination of the space.Nine were double disc herniation.All cases were treated with TLIF technique.A retrospective analysis on surgical therapeutic effect was made.[Results]Five patients developed complications after operation and recovered by symptomatic treatment.Patients moved around in 2~3 d after surgery.Oswestry score improved from(52.32 ?9.17)to(20.33 ?5.72)in an average 15-months follow-up.X-ray showed that all cases had bone graft fusion and no adjacent segment degeneration occurred.[Conclusion]TLIF technique is an effective method in treatment of upper lumbar intervertebral disc herniation.It can offer satisfactory clinical effects.

Multi-access for the Diagnosis of Missed Upper Lumbar Disc Herniation

Herein, a case of missed upper lumbar disc herniation, diagnosed by thorough neurological examination, digital infrared thermographic imaging(DITI), and repeated magnetic resonance(MR) image study, is reported. A 36-year-old female presented with intractable leg pain on left anterior thigh. Although she underwent lumbar MR image at other hospital, she was misdiagnosed as acute sprain. Neurological examination suggested the possibility of upper lumbar disc herniation, which was confirmed by DITI, MRI, and selective root block. After operation, her leg pain was significantly improved. It should be considered that upper lumbar disc herniation might be misdiagnosed as an acute sprain, as in our case. A high index of suspicion based on thorough neurological examination is most important in such cases. Then, multi-access such as DITI, MR image, and selective block, base on thorough neurological examination, are warranted.

Simultaneous Paraspinal and Midline Approach for Upper Lumbar Disc Herniation: Technique to Prevent Lamina Fracture

OBJECTIVE: Upper lumbar disc herniation is rare disease, compared with lower. The lamina of this high level lumbar vertebra is narrower than that of low level, and this have taken surgeon into important consideration for surgical methods because partial removal of lamina for discectomy weakens the base of the articular process and may result in fracture. The authors an accurate preoperative diagnosis that enables the surgeon to operative approach for preserving the facet joint. METHODS: Thirteen patients with upper lumbar disc herniation have underone surgical procedure by midline approach for removal of ruptured disc fragment and paraspinal approach for removal of residual disc materials simultaneously without instrumentation. All patients who underwent surgery were analyzed and long-term follow-up was conducted. RESULTS: At a mean follow-up of 24months, there were complete resolution of presenting radiating leg pain in 85% of the patients, 7.5% were left with minimal residual discomfort, and 7.5% derived little or no benefit from surgery. The follow-up radiologic findings of all patients shows that lamina and facet joint have preserved safely and no instability. CONCLUSION: Simultaneously, paraspinal with midline approach provides highly satisfactory operating methods by simplifying exposure and greatly limiting the risk of complications. This provides the basis for a planned surgical approach in which destruction of the facet joint can be avoided.

L1-2 Disc Herniations: Clinical Characteristics and Surgical Results

OBJECTIVE: Among upper lumbar disc herniations, L1-2 disc herniations are especially rare. We present the specific clinical features of L1-2 disc herniation and compared results of different surgical options. METHODS: The authors undertook a retrospective single institution review of the patients who underwent surgery for L1-2 disc herniation. Thirty patients who underwent surgery for isolated L1-2 disc herniations were included. RESULTS: Buttock pain was more frequent than anterior or anterolateral thigh pain. Standing and/ or walking intolerance was more common than sitting intolerance. The straight leg raising test was positive only in 15 patients (50%). Iliopsoas weakness was more frequent than quadriceps weakness. Percutaneous discectomy group demonstrated worse outcome than laminectomy group or lateral retroperitoneal approach group. CONCLUSION: Standing and/or walking intolerance, positive femoral nerve stretch test, and iliopsoas weakness can be useful clues to the diagnosis of L1-2 disc herniation. Posterior approach using partial laminectomy and medial facetectomy or minimally invasive lateral retroperitoneal approach seems like a better surgical option for L1-2 disc herniation than percutaneous endoscopic discectomy.