Upper lumbar disc herniations.
This study reviews the presentation, diagnosis, and outcomes of upper lumbar disc herniations (L1-2, L2-3, L3-4). One hundred forty-one patients operated upon at three centers between 1980 and 1990 were analyzed (102 men, 39 women; 3 L1-2, 21 L2-3, 117 L3-4; average age 51.6 years; 10.4% of all lumbar discectomies performed). Preoperative signs and symptoms were highly variable. Sensory, motor, and reflex testing was variable and potentially misleading in suggesting a level of herniation. In analyzing radiographic studies (noncontrast CT, myelography, MRI) individually and using other radiographic studies and operative findings as a standard for comparison, a high false-negative rate was found for all studies when considered individually, especially at the higher L2-3 level. Intraoperative radiographs were employed with increasing frequency as the level of herniation ascended. Six operative complications (4.3%) were identified, all of which were treated and were resolving at the time of discharge. Follow-up obtained at an average of 2.2 years in 87% of patients by chart review showed no reoperations or late complications. Noncompensation patients had a significantly higher percentage of good/excellent results (86%) than those with compensation or legal claims pending (45% good/excellent results). Based upon these data, we recommend myelogram with postmyelogram CT and/or MRI in the workup of these patients and intraoperative radiographs in all cases when decompressing an upper lumbar disc herniation. Patients with compensation/legal claims should be approached cautiously, because their subjective results are significantly worse than those of noncompensation patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Albert
T J
TJ
Thomas Jefferson University Hospital, Pennsylvania Hospital, Philadelphia.
Balderston
R A
RA
Heller
J G
JG
Herkowitz
H N
HN
Garfin
S R
SR
Tomany
K
K
An
H S
HS
Simeone
F A
FA
D000328:Adult; D000368:Aged; D003952:Diagnostic Imaging; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology / Q000601:surgery; D017116:Low Back Pain / Q000453:epidemiology / Q000209:etiology / Q000523:psychology; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D011859:Radiography; D012021:Reflex, Abnormal; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013126:Spinal Nerve Roots; D016896:Treatment Outcome