Our Clinical Experience in Upper Lumbar Hernia: Retrospective Evaluation of 47 Patients

Authors : Güray Bulut

Pages : 73-81

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Publication Date : 2020-05-31

Article Type : Research

Abstract :Clinical and radiological examination of upper level lumbar disc hernias (L1-2, L2-3, L3-4) and evaluation of surgical results. 47 patients with upper level lumbar disc hernia (ULLDH) among 282 lumbar disc hernias (LDH) performed in our clinic between April 2015 and April 2017. Age, physical examination, disc distances, radiological findings, preoperative and postoperative findings, complications, recurrence, patient satisfaction were evaluated retrospectively according to Prolo scale (via two 5-point Likert-type scales). Maximum resection principle was applied in the operations. All patients were operated with direct lumbar radiographs and lumbar magnetic resonance imaging (MRI). Lumbar computer tomography and electromyography (EMG) were performed and the diagnoses were supported when necessary. 23 (48.9%) of the cases were male and 24 (51.1%) were female. The average age was 49.9 (25-70). The average period between occurrence of symptoms and attendance to clinic is 3.7 months. The occurrence of L1-2: 3 (6.4%) patients, L2-3: 8 (17%) patients and L3-4: 32 (68.1%) in ULLDH cases (16.6%). Four patients (8.5%) with L2-3 and L3-4 were present. The first operation was not recurred during the 2-year follow-up in our clinic. Spondylodiscitis developed in 1 patient (2.1%) and was improved with medical treatment. In 1 patient (2.1%) preoperative dural injury primer was also repaired. In the early postoperative period, leg pain was disappeared in all cases. According to the Prolo follow-up scale, 31.9% were good and 65.96% were excellent. No bad results had been recorded. The incidence of ULLDH is increasing with the widespread use of MRI. ULLDH, with careful microsurgical technique and maximum disc resection, if operated, surgical success rate increases and complication rate decreases.
Keywords : Upper, disc, hernia, lumbar, microdiscectomy