J Korean Neurosurg Soc.  2013 Nov;54(5):379-383. 10.3340/jkns.2013.54.5.379.

The Comparative Analysis of Clinical Characteristics and Surgical Results between the Upper and Lower Lumbar Disc Herniations

• Lee DS
• Park KS
• Park MS

• KMID: 2138352
• DOI: http://doi.org/10.3340/jkns.2013.54.5.379

Abstract

OBJECTIVE
There are differences in the clinical characteristics and surgical results between upper (L1-2 and L2-3) and lower (L3-4, L4-5, and L5-S1) lumbar disc herniations. We conducted this study to compare the clinical features and surgical outcomes between the two types of lumbar disc herniations.
METHODS
We retrospectively reviewed the clinical features of patients who underwent microdiscectomies from 2008 to 2012. We evaluated the clinical characteristics such as age, preoperative autonomic dysfunction, the presence or absence of previous lumbar surgery and fusion required during surgery. Visual Analogue Scale (VAS) scores about back pain and leg pain were evaluated preoperatively and at the final follow-up.
RESULTS
Upper lumbar group (n=15) was significantly older than lower lumbar group (n=148). The incidence of autonomic dysfunction was significantly higher in upper lumbar group. The number of patients with a previous lumbar surgery was significantly greater in upper lumbar group. There was no statistical significance for fusion required during surgery between two groups. Both groups showed a significant decrease in the VAS scores of leg pain. VAS scores of back pain were significantly decreased in lower lumbar group. But this was not seen in upper lumbar group. Both groups showed significant improvement of Oswestry Disability Index score.
CONCLUSION
Upper lumbar group had different clinical characteristics from those of lower lumbar group and these include older age, a higher incidence of autonomic dysfunctions and a higher incidence of patients with previous lumbar surgery. There were no significant differences in surgical outcomes, except for back pain, between two groups.

Keyword

Lumbar disc herniation; Upper lumbar; Clinical characteristics; Surgical outcome

MeSH Terms

Back Pain
Follow-Up Studies
Humans
Incidence
Leg
Retrospective Studies

Figure

• 

  Fig. 1 Schematic drawings showing distribution of pain or sensory change in 15 patients of upper lumbar group. 1) anterior thigh (n=5), 2) anterolateral thigh (n=3), 3) inguinal (n=1), 4) anterolateral lower leg (n=4), 5) foot dorsum (n=1), 6) buttock (n=13), 7) perianal (n=1), 8) posterolateral thigh (n=7), 9) calf (n=3).

• 

  Fig. 2 Comparison of the degree of the reduction in the severity of back pain and leg pain between preoperatively and at 24 month after surgery in upper lumbar (A) and lower lumbar (B) groups. VAS : Visual Analogue Scale, preop : preoperative, f/u : follow-up at 24 months after surgery.

• 

  Fig. 3 Comparison of the degree of the reduction in the Oswestry Disability Index between preoperatively and at 24 months after surgery in both groups. preop : preoperative, f/u : follow-up at 24 months after surgery.

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