Egyptian Spine Journal (Apr 2015)
Surgical Excision of Upper Lumbar Disc Herniations
Abstract
Background Data: Disc herniations at the L1/2 and L2/3 levels are different from those at lower levels of the lumbar spine with regard to clinical characteristics and surgical outcome. Spinal canals are narrower than those of lower levels, which may compromise multiple spinal nerve roots or conus medullaris. Purpose: The aim of this study to evaluate the clinical features and surgical outcomes of upper lumbar disc herniations. Study Design: A prospective descriptive clinical case study. Patients and Methods: Thirty patients underwent surgeries for single fresh lumbar disc herniation at the L1/L2 or L2/3 levels. They were operated between 2011 and 2014. Participants were evaluated pre-operatively and post-operatively at 3, 6, 9, and 12 month intervals. Pain was scored by a VAS for both lower limb and back pain. The clinical outcomes were compared using the Prolo economic and functional rating scale. Results: The affected levels were L1/2 in 9 patients and L2/3 in 21 patients. The mean age of patients was 52.5 years and (Range=29-67). The mean follow-up period was 13.6 months. Most patients complained of back and buttock pain (27 patients, 90%), and radiating pain in areas such as the anterior or anterolateral aspect of the thigh (23 patients, 77%). Weakness of lower extremities was observed in 12 patients (39%) and sensory disturbance was presented in 15 patients (50%). Only 4 patients (13%) had undergone previous lumbar disc surgery (One patient at L1-2 and the other 3 patients at L4-5 level). Discectomy was performed in all patients. The mean values of preoperative back pain by VAS were 7.7±0.3. The mean values of radicular pain were 8.3±1.4. The mean values of preoperative Prolo Scale were 5.1±0.7. At 1 year follow up the mean back pain on VAS decreased significantly to 2.6±0.4 (P<0.01) and the mean lower limb pain on VAS also decreased significantly to 2.5 ±0.5 (P<0.01). When the outcome was evaluated by the Prolo scale, 23% (7 of 30) of all the patients experienced excellent results, 50% (15 of 30) had good results, 23% (7 of 30) had fair results, and 3% (1 of 30) had poor results. By 12 months follow up period, 73% of the study group expressed clinical success. Conclusion: Clinical features of disc herniations at the L1/2 and L2/3 levels were variable, and localized sensory change or pain was rarely demonstrated. In most cases, the discectomy was performed successfully by conventional posterior laminectomy. (2015ESJ088)
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