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Shin, Ahn, Cho, Yoon, Kim, Bang, and Cha: Herniation of Upper Lumbar Disc - Clinical Finding & Surgical Result -
Original Research

J Korean Soc Spine Surg 2012;19(3):103-109.

Published online: 18 September 2012

DOI: https://doi.org/10.4184/JKSS.2021.19.3.103

Herniation of Upper Lumbar Disc - Clinical Finding & Surgical Result -

Dong-Eun Shin, M.D., Chang-Soo Ahn, M.D.∗, , Duck-Yun Cho, M.D., Hyung-Ku Yoon, M.D., Tae-Hyung Kim, M.D.†, Jin-Young Bang, M.D., Yoon-Sik Cha, M.D.

Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University of Korea

∗Department of Orthopaedic Surgery, CHA Gumi Medical Center, CHA University of Korea

†Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, Catholic University of Korea

Corresponding author: Chang-Soo Ahn, M.D. Department of Orthopaedic Surgery, CHA Gumi Medical Center, CHA University, 855 Hyungkok-dong, Gumi-si, Gyeongsangbuk-do 730-040, Korea TEL: 82-31-780-5289, FAX: 82-31-708-3578 E-mail: shinde@cha.ac.kr

Received 6 April 201121 June 2012       Accepted 14 September 2012

© Copyright 2012 Korean Society of Spine Surgery

“This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.”

Abstract

Study Design

A retrospective study.

Objectives

We attempted to establish an efficient diagnosis and treatment modality by analyzing clinical manifestations and operative results of upper lumbar disc herniations.

Summary of Literature Review

Upper lumbar disc herniations represented a lower incidence but have become easier to diagnose by predictable clinical aspects and an MRI scan. The operative results have been satisfactory.

Materials and Methods

We evaluated 41 cases, which were operated with posterior laminectomy and discectomy from September, 1996 to November, 2009. We analyzed preoperative history, clinical and MRI findings, and then assessed operative results by Kim's criteria and functional change in the follow up.

Results

The prevalence of upper lumbar disc herniations in all disc herniations was 8.8%. Pre-operative manifestations were lower back pain (85.4%), radiating pain (80.5%), sensory deficit (53.7%), motor deficit (53.7%), and depressed knee jerk (65.9%). The positive rate of the femoral stretching test (78.0%) was higher than the straight leg raising test (39.0%). The VAS score changed from preoperative 9.0±0.8 into postoperative 1.4±1.3 points. The operative results were excellent or good in 82.9%. The rate of resuming previous work, including slight modification was 90.2%.

Conclusions

Predictable clinical aspects of the upper lumbar disc herniations are anterior thigh pain with lower back pain, variable motor deficit, sensory deficit, depressed knee jerk and the positive femoral nerve stretching test. Through careful examination and radiological evaluations such as MRI, operative treatment can obtain a symptomatic improvement and satisfactory results.

Keywords: Upper lumbar disc, Herniation, Operative treatment, Results

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Fig. 1. T2 L-spine MRI image (A) Saggital image: Left central extrusion of disc at L2-3 with inferior migration to L3 low body level. (B) Axial iamge: As-sociated with compression of the thecal sac and left L3 nerve root
jkss-19-103f1.tif
Table 1.
Kim's Criteria for Clinical Result
Excellent Complete relief of pain in back and lower limbs
No limitation of physical activity
Analgesics not used
Able to squat on the floor
Good Relief of most pain in back and lower limbs
Able to return to accustomed employment
Physical activities slightly limited
Analgesics used only infrequently
Able to squat on the floor
Fair Partial relief of pain in back and lower limbs
Able to return to accustomed employment with limitation or return to
Mild limitation to squat on the floor
Poor Little or no relief of pain in back and lower limbs
Physical activities greatly limited
Unable to return to accustomed employment
Analgesic medication use regularly
Unable to squat on the floor without support
Table 2.
Level and sex distribution in upper lumbar disc herniations
Level Sex Total Percentage
Male Female
L1-2 only 2 0 2 4.9%
L2-3 only 5 4 9 22.0%
L3-4 only 18 8 26 63.4%
L1-2 & L3-4 1 3 4 9.8%
L2-3 & L3-4 0 0 0 0%
Total 26(63.4%) 15(36.6%) 41 100%
Table 3.
Combined spinal disorders
Disorders L1-2 L2-3 L3-4 L1-2, L3-4 L2-3, L3-4 Total
Spinal stenosis 1 2 3 2   8
Spondylolithesis     3 2   5
Bulging in lower lumbar 1 2 7     10
Total 2 4 13 5 0 23
Table 4.
Symptomatic improvement of the operative treatment
  Pre-operative Follow Up Percentage of improvement (%)
Number % Number %
Low back pain 35 85.4% 9 22.0% 26/35(74.3%)
Radiating pain 33 80.5% 4 9.8% 29/33(87.9%)
Motor deficit 22 53.7% 9 22.0% 13/22(59.1%)
Sensory deficit 22 53.7% 8 19.5% 14/22(63.7%)
Table 5.
The change of SLRT and VAS
  Mean SLRT# Mean VAS$
Pre-operative 60.8±13.9° 9.0±0.8
Post-operative 76.6±6.4° 1.4±1.3

# SLRT; Straight leg raising test(P<0.001)

$ VAS; Visual analogue pain scale(P<0.001)

Table 6.
Type of upper lumbar HNP
Type Protrusion Extrusion Sequestrum Total
Number 6 8 27 41
Percentage 14.6% 19.5% 65.9% 100%
Table 7.
Results of surgical treatment related to disc level
Type (Kim's criteria) L1-2 L2-3 L3-4 L1/2,L3/4 L2/3,L3/4 Total %
Excellent   5 19 1 1 26 63.4%
  Good 1 2 6 2   11 26.9%
  Fair 1 1 1     3 7.3%
  Poor       1   1 2.4%
  Total           41 100.0%
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