Abstract
BackgroundSurgical outcomes of upper lumbar disc herniations (ULDHs) including T12-L1, L1-L2, and L2-L3 levels are characteristically less favorable and more unpredictable.ObjectivesThis study was conducted to compare the surgical outcomes of decompression alone versus decompression combined with transpedicular screw fixation in treating upper lumbar disc herniation.MethodsThis retrospective cohort study was carried out at Neurosurgery Departments, Tanta University. The study included 46 patients with a symptomatic high lumbar herniated disc at T12-L1, L1-L2, and L2-L3 levels. The enrolled patients were divided into two groups depending on whether they were operated on via decompression and partial medial facetectomy (group 1, 22 patients) or via the previous maneuver plus transpedicular screw fixation (group 2, 24 patients). All patients were medically evaluated immediately after the operation; then, they were followed up at the 3rd and the 6th months following surgery. Patients’ outcomes were assessed by visual analogue score (VAS) and Oswestry Disability Index (ODI) scores.ResultsMedian VAS scores in each group revealed significant reduction immediately following surgery and at each of 7 days, 3 months, and 6 months in comparison with the preoperative VAS score (p<0.001). Furthermore, each group showed significant stepwise reduction in the median ODI score at the 3rd and the 6th months postoperative compared to the preoperative ODI score (group 1 = 68.0, 19.0, 15.0; p< 0.001 and group 2 = 66.5, 20.0, 15.0; p< 0.001), with no significant differences between both groups (p> 0.05).ConclusionsBoth standalone decompression and decompression combined with transpedicular screw fixation revealed comparable favorable outcomes in patients with ULDH.
Highlights
Lumbar disc herniation (LDH) is widely known as bulging of the disc material beyond the limit of the intervertebral disc space
The upper herniations are defined as either L1-L2 and L2-L3 only or expanded to include T12-L1, L1-L2, and L2-L3 levels as well [2]
The L1-L2 and L2-L3 levels are less common in comparison to lower lumbar disc herniations
Summary
Lumbar disc herniation (LDH) is widely known as bulging of the disc material beyond the limit of the intervertebral disc space. Anatomical classifications of the lumbar disc herniations are either upper or lower ones. The upper herniations are defined as either L1-L2 and L2-L3 only or expanded to include T12-L1, L1-L2, and L2-L3 levels as well [2]. The L1-L2 and L2-L3 levels are less common in comparison to lower lumbar disc herniations. Their incidence has been reported to be 1–2% of all herniated lumbar discs [3]. Surgical outcomes of upper lumbar disc herniations (ULDHs) including T12-L1, L1-L2, and L2-L3 levels are characteristically less favorable and more unpredictable
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