Herniated Disc at the Upper Lumbar Region: Surgical Technique and Clinical Outcomes

Background Data: Upper lumbar disc herniation involving D12/L1, L1/L2, and L2/L3 levels is less prevalent than lower lumbar discs. In terms of clinical characteristics and surgical managements, they are different from those at the lower levels of the lumbar spine. Spinal canals are narrower than those of the lower levels, which may compromise multiple spinal nerve roots or conus medullaris with higher complication rate with surgical intervention. Purpose: To investigate the clinical features and surgical outcomes of patients operated on for upper lumbar disc herniations. Study Design: Retrospective clinical cohort study. Patients and Methods: This study included 20 patients diagnosed with herniated disc at upper levels (T12-L1, L1-L2, and L2-L3). Patients were operated on during the period between June 2015 to March 2017. All patients were operated on via transfacet approach with pedicle screw fixation. Postoperative data including clinical and neurological outcomes and radiographic imaging have been collected. Postoperative follow-up evaluation included immediate postoperative medical records and a postoperative visit to the outpatient clinic until 18 months postoperatively. Patients’ outcomes were assessed using Visual Analogue Scale of radicular and back pain and Oswestry Disability Index (ODI) as functional score. Results: Over a mean follow-up period of 13±2.5 months, there was significant improvement in radicular pain (P = 0.0026) and back pain (P = 0.049) and myelopathy and statistically significant improvement in Oswestry Disability Index (ODI) (P = 0.0032) compared to the preoperative value. No postoperative complications were detected in this series. Conclusion: This approach offers a safe technique for decompression and stabilization at lower thoracic and upper lumbar region. (2019ESJ178)