Abstract
Upper lumbar herniated intervertebral disc (HIVD), defined as L1-2 and L2-3 levels, presents with a lower incidence and more unfavorable surgical outcomes than lower lumbar levels. There are very few reports onthe appropriate surgical interventions for treating upper lumbar HIVD. This study aimed to evaluate the surgical outcome of decompression alone, when compared with spinal fusion surgery. A retrospective study involving a total of 7592 patients who underwent surgery due to HIVD in our institution was conducted. A total of 49 patients were included in this study: 33 patients who underwent decompression-only surgery and 16 patients who underwent fusion surgery. Demographic data, perioperative information, and functional outcomes were recorded. The visual analog scale (VAS) scores showed improvement in both groups postoperatively. The three-month postoperative Oswestry Disability Index score was significantly better in the fusion group. Additionally, 10 patients (76.9%) in the decompression group and 5 patients (83.3%) in the fusion group reported improvement in preoperative motor weakness. The final “satisfactory” rate was 66.7% in the decompression group and 93.8% in the fusion group (p = 0.034). The overall surgical outcomes of patients with upper lumbar HIVD were satisfactory in this study without any major complications. More reliable satisfactory rates and better functional scores at the three-month postoperative follow-up were reported in the fusion group.
Highlights
Upper lumbar herniated intervertebral disc(HIVD), defined as L1-2 and L2-3 levels, presents with a low incidence of about 1% of all lumbar HIVD [1]
Sanderson et al [2] presented a chart review study that showed less than 60% of patients in the L1-2 and L2-3 group experienced any improvement of their pain postoperatively
The purpose of this study is to evaluate the surgical outcomes of decompression alone compared with spinal fusion surgery in treating upper lumbar HIVD
Summary
Upper lumbar herniated intervertebral disc(HIVD), defined as L1-2 and L2-3 levels, presents with a low incidence of about 1% of all lumbar HIVD [1]. Due to the anatomical characteristics of the upper lumbar spine, the clinical symptoms and signs are non-specific and different from those in lower lumbar HIVD [2,3]. The surgical outcome for upper lumbar HIVD showed to be more unpredictable than for lower lumbar HIVD in results from previous studies in early years [7]. Sanderson et al [2] presented a chart review study that showed less than 60% of patients in the L1-2 and L2-3 group experienced any improvement of their pain postoperatively. Preoperative symptoms improved significantly in 80.5% of patients
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