Analysis of Clinical and Surgical Outcomes of Upper Lumbar Disk Herniations

Abstract

Objective: Upper disk herniation levels (L1-L2, L2-L3, L3-L4) are different from those at lower levels of the lumbar spine (L4-L5, L5-S1) with regard to clinical and anatomic characteristics and surgical outcome. In the upper lumbar region, the spinal canal is narrower and it may compromise more spinal nerve roots or the conus medullaris. The aim of this study was to evaluate the surgical outcomes and clinical characteristics of upper lumbar disk herniations. Methods: We diagnosed 272 upper lumbar disk herniations of 3045 patients who had undergone surgical treatment for lumbar disk herniations from 2006 to 2011. This retrospective study reviewed 127 patients with complete records. We divided upper lumbar disk herniations into 2 groups: L1-L2+L2-L3 levels as group I and L3-L4 level as group II. Patient’s age, sex, presenting symptoms and signs, clinical characteristics, radiologic findings, operative methods, and surgical outcomes were investigated. Prolo economic and functional scale was used to evaluate patient’s satisfaction results. Results: Of the 127 patients, 55% were male and aged from 22 to 80 years (mean 51 y). Of the 127 patients, 102 (80%) were at L3-L4, 17 (13%) at L2-L3, and 8 (6%) at L1-L2 levels. Most of the patients complain of back pain (84% in group I and 84.3% in group II) and leg pain (88% in group I and 90.2% in group II). Weakness of lower extremities were observed in 56% of patients in group I and 61.8% of patients in group II, sensory disturbance in 80% in group I and in 75.5% in group II, loss of reflex in 36% in group I and in 32.4% in group II, sphincter dysfunction in 8% in group I and in 6.9% in group II, cauda equine syndrome in 8% in group I and in 2.9% in group II, and neurological claudication in 38% in group I and in 27.5% of patients in group II. Discectomy was performed using these 3 methods: unilateral microdiscectomy in 72% of patients, bilateral microdiscectomy in 17% of patients, and total laminectomy and discectomy in 11% of patients. The mean follow-up period was 17 months (range, 1 to 48). According to Prolo economic and functional scale, preoperative symptoms improved in 65.4% of patients, partially in 27.5% of patients, and were poor in quality in 7.1% of patients. The outcomes of patients in groups I and II were similar. Conclusions: In upper lumbar disk herniation clinical features, weakness, pain, and sensory disturbance are the main complaints and are different from those of lower levels of the lumbar spine. Furthermore, loss of reflex is less seen according to lower lumbar disk herniations. The L3-L4 level is excluded from the upper lumbar disk in some reports; however, in our study, clinical characteristics and outcomes in both the groups were statistically similar (P>0.05). Therefore, the upper lumbar disk term for L1-L2, L2-L3, and L3-L4 disk levels is appropriate.