Diagnosis and surgical outcome of upper lumbar herniated intervertebral disc: 47 cases from a review of 7,491 patients

Background: Upper lumbar herniated intervertebral disc (HIVD) is clinically different from the lesion at the lower lumbar spine. Clinical symptoms in previous reports are more unspecific. Precise diagnosis and good surgical outcomes are difficult. Purpose: We aimed to investigate the clinical presentations and prognosis of upper lumbar HIVD. Methods: Data of 47 patients who were diagnosed with upper lumbar disc herniation underwent surgery from January 2000 to June 2017 in our institution were retrospectively reviewed. The lesion was at the L1-L2 level in 8 patients and L2-L3 level in 38 patients. One patient had HIVD at both levels. Clinical symptoms, patient characteristics, surgical methods, and prognosis were reviewed. Results: A total of 47 patients were followed up for a mean period of 39.3 months. The average age was 56.4 years. The major symptom in upper lumbar disc herniation was lower back and buttock pain, recorded in 30 and 5 patients, respectively. Thirty-one patients (76.6%) had pain or numbness in the anterior thigh, lateral hip, or inguinal region, which is compatible with the upper lumbar dermatome. Thirty-three patients underwent discectomy with decompression, and 11 underwent posterior instrumentation with interbody fusion. Three patients underwent nerve block as treatment. Of the patients, 76.6% had a satisfactory outcome with no major complications noted. Conclusion: The clinical presentations of upper lumbar disc herniation were usually compatible with upper lumbar level pathology. Based on history taking, physical examination, and image study, an accurate diagnosis can be achieved. Most patients had a satisfactory surgical outcome.