Abstract
BackgroundAt present, much is unknown about the etiology and pathogenesis of ULDH. However, it is interesting to note that many ULDH patients have a radiographic feature of adjacent vertebral wedge deformation. The purpose of this study is to investigate the relationship between symptomatic upper lumbar disc herniation (ULDH) and wedge-shaped vertebrae (WSV).MethodsThis was a retrospective study of 65 patients with single-level ULDH, who had undergone surgery at our medical center between January 2012 and December 2016. Clinical data including clinical and radiological evaluation results were performed.ResultsThe incidence of WSV in the ULDH group (44.6%, 29/65) was more than in the lower lumbar disc herniation group (21.5%, 14/65). And there were statistically significant differences in WSV (χ2 = 7.819, P = 0.005), wedging angle of the vertebrae (WAV) (t = 9.013, P < 0.001), and thoracolumbar kyphotic angle (TL) (t = 8.618, P < 0.001) between two groups. Based on multivariate logistic regression analysis, WAV (OR = 0.783, 95% CI = 0.687–0.893, P < 0.001) and TL (OR = 0.831, 95% CI = 0.746–0.925, P = 0.001) were independently associated with ULDH. The cutoff values of WAV and TL were 5.35° and 8.35°, which were significantly associated with ULDH (OR = 3.667, 95% CI = 1.588–8.466, P = 0.002).ConclusionThe WSV is an independent risk factor for ULDH. WAV > 5.35° and TL > 8.35° were the predictors for ULDH. It should be noted that the patients with vertebral wedge deformation combined with thoracolumbar kyphosis have a higher risk of ULDH.
Highlights
At present, much is unknown about the etiology and pathogenesis of upper lumbar disc herniation (ULDH)
The incidence of wedge-shaped vertebrae (WSV) was detected in 44.6% (29/65) of ULDH patients treated, and the average
We further found that the WSV is an independent risk factor for ULDH, and multivariate logistic regression analysis and cutoff values have shown that the existence of two factors (WAV > 5.35° and thoracolumbar kyphotic angle (TL) > 8.35°) was significantly correlated with ULDH
Summary
It is interesting to note that many ULDH patients have a radiographic feature of adjacent vertebral wedge deformation. The purpose of this study is to investigate the relationship between symptomatic upper lumbar disc herniation (ULDH) and wedge-shaped vertebrae (WSV). Lumbar disc herniation (LDH) is defined as a prolapse of the nucleus pulposus from a defect in the annulus fibrosus forming the circumferential rim of the disc. L1/2 and L2/3 disc herniation, which defined as upper lumbar disc herniation (ULDH), are very rare (< 5%) [1, 2]. ULDH may have different clinical signs than ordinary lower lumbar disc herniation (LLDH) at the levels from L3/4 to L5/S1 in clinical practice. We noted that numerous symptomatic ULDH patients visiting our institution had adjacent vertebral wedge-shaped deformities. Symptomatic ULDH in the context of wedgeshaped vertebrae (WSV) has been recognized to occur, it is still controversial and limited number of cases reported made it difficult to judge the relationship between the ULDH and WSV [6,7,8]
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