J Korean Soc Spine Surg.  2012 Sep;19(3):103-109. 10.4184/jkss.2012.19.3.103.

Herniation of Upper Lumbar Disc: Clinical Finding & Surgical Result

• Shin DE
• Ahn CS
• Cho DY
• Yoon HK
• Kim TH
• Bang JY
• Cha YS

• KMID: 1435587
• DOI: http://doi.org/10.4184/jkss.2012.19.3.103

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 pre-operative 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.

Keyword

Upper lumbar disc; Herniation; Operative treatment; Results

MeSH Terms

Diskectomy
Femoral Nerve
Incidence
Knee
Laminectomy
Leg
Low Back Pain
Magnetic Resonance Imaging
Prevalence
Retrospective Studies
Thigh

Figure

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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

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