Surgical Outcomes for Upper Lumbar Disc Herniation: Decompression Alone versus Fusion Surgery

Abstract

Upper lumbar herniated intervertebral disc (HIVD), defined as L1-2 and L2-3 levels, presents with a lower incidence and more unfavorable surgical outcomes than lower lumbar levels. There are very few reports onthe appropriate surgical interventions for treating upper lumbar HIVD. This study aimed to evaluate the surgical outcome of decompression alone, when compared with spinal fusion surgery. A retrospective study involving a total of 7592 patients who underwent surgery due to HIVD in our institution was conducted. A total of 49 patients were included in this study: 33 patients who underwent decompression-only surgery and 16 patients who underwent fusion surgery. Demographic data, perioperative information, and functional outcomes were recorded. The visual analog scale (VAS) scores showed improvement in both groups postoperatively. The three-month postoperative Oswestry Disability Index score was significantly better in the fusion group. Additionally, 10 patients (76.9%) in the decompression group and 5 patients (83.3%) in the fusion group reported improvement in preoperative motor weakness. The final “satisfactory” rate was 66.7% in the decompression group and 93.8% in the fusion group (p = 0.034). The overall surgical outcomes of patients with upper lumbar HIVD were satisfactory in this study without any major complications. More reliable satisfactory rates and better functional scores at the three-month postoperative follow-up were reported in the fusion group.

Treatment of Upper Lumbar Disc Herniation with a Transforaminal Endoscopic Technique

“…For patients that fail to respond to conservative treatment, surgical treatment should be carried out. Traditional surgical methods include lumbar microdiscectomy and lumbar discectomy combined with intervertebral fusion ( 11 ). Open surgery for the treatment of upper LDH has a satisfactory clinical effect, but the operation requires extensive traction and dissection of paravertebral soft tissues, which tends to impair the stability of intervertebral joints and ligaments and results in increased surgical trauma ( 5 ).…”

Failed Back Surgery Syndrome: No Longer a Surgeon’s Defeat—A Narrative Review

“…Incidental durotomy may result in persistent pain through various mechanisms, including direct injury to the nerves or inflammation [ 33 ]. Inadequate or inaccurate decompression during surgery can lead to the persistence or worsening of pain [ 34 ].…”

Unilateral biportal endoscopy via two different approaches for upper lumbar disc herniation: a technical note

“…Some authors have reported upper lumbar discs as T12-L1, L1-L2, L2-L3, and L3-L4 [1], while some other studies have considered them as only L1-L2 and L2-L3 [2]. The spinal canals of upper lumbar discs are narrower than those of the lower ones, which may compromise multiple spinal nerve roots or conus medullaris and lead to complex and variable signs [3]. The traditional treatments for ULDH include open posterior lumbar interbody fusion [4], transforaminal lumbar interbody fusion [5], and posterior decompression [6], and only nucleus pulposus enucleation via intervertebral foramen (or fenestration of laminar space).…”