ORIGINAL
Introdução: As hérnias discais lombares superiores são muito menos comuns do que as hérnias discais lombares inferiores. Objetivo: comparar os achados clínicos e os resultados cirúrgicos de pacientes com hérnia de disco L2-3 e L3-4. Métodos: Neste estudo de caso-controle, analisamos retrospectivamente os resultados clínicos de 39 pacientes com diagnóstico de hérnia de disco L2-L3 (n=15) e L3- L4 (n=24) operados ao microscópio com facetectomia 1/3 medial e técnica de discectomia convencional no período de 2015 a 2019. Resultados: Uma diminuição significativa foi detectada nas pontuações da Escala Visual Analógica de dor lombar e dor nas pernas e as pontuações modificadas do Índice de Incapacidade de Oswestry na 1ª semana pós-operatória em ambos os grupos L2-L3 e L3-L4 (p<0,001). De acordo com os critérios de Odom modificados, as taxas de melhora dos pacientes no primeiro ano de pós-operatório foram de 93,8% (resultados excelentes e bons) no grupo L2-L3 e 84,6% (resultados excelentes e bons) no grupo L3-L4 (p>0,05). Conclusão: Foi determinado que as características clínicas pré-operatórias das hérnias discais L3-4 eram semelhantes às das hérnias discais lombares inferiores, enquanto os resultados clínicos pós-operatórios eram consistentes com as hérnias discais lombares superiores.
Introduction: Upper Lumbar disc herniations (LDH) are much less common than lower lumbar disc herniations. Objective: to compare the clinical findings and surgical outcomes of patients with L2-3 and L3-4 disc herniation (DH). Methods: In this case-control study, we retrospectively analyzed the clinical results of 39 patients diagnosed with L2-L3 (n=15) and L3-L4 (n=24) disc herniation who were operated on under the microscope with 1/3 medial facetectomy and conventional discectomy technique in the period of 2015 to 2019. Results: A significant decrease was detected in the low back pain and leg pain Visual Analog Scale (VAS) scores and the modified Oswestry Disability Index (mODI) scores in the postoperative 1st week in both the L2-L3 and L3-L4 groups (p<0.001). According to the modified Odom’s criteria; the postoperative 1st year improvement rates of the patients were 93.8% (excellent and good results) in the L2-L3 group and 84.6% (excellent and good results) in the L3-L4 group (p>0.05). Conclusion: Preoperative clinical features of L3-4 DHs were determined similar to those of lower LDHs, whereas the postoperative clinical outcomes were consistent with upper LDHs.
1. Iwasaki M, Akino M, Hida K, et al. Clinical and radiographic characteristics of upper lumbar disc herniation: ten-year microsurgical experience. Neurol Med Chir (Tokyo). 2011;51(6):423-6. http://dx.doi. org/10.2176/nmc.51.423. PMid:21701105.
2. Awwal MA, Ahsan MK, Sakeb N. Outcome of symptomatic upper lumbar disc herniation. Mymensingh Med J. 2014;23(4):742-51. PMid:25481595.
3. Sanderson SP, Houten J, Errico T, Forshaw D, Bauman J, Cooper PR. The unique characteristics of “upper” lumbar disc herniations. Neurosurgery. 2004;55(2):385-9, discussion 389. http://dx.doi. org/10.1227/01.NEU.0000129548.14898.9B. PMid:15271245.
4. Albert TJ, Balderston RA, Heller JG, et al. Upper lumbar disc herniations. J Spinal Disord. 1993;6(4):351-9. http://dx.doi. org/10.1097/00002517-199306040-00009. PMid:8219549.
5. Pásztor E, Szarvas I. Herniation of the upper lumbar discs. Neurosurg Rev. 1981;4(3):151-7. http://dx.doi.org/10.1007/BF01743641. PMid:7301145.
6. Lee SH, Choi SM. L1-2 disc herniations: clinical characteristics and surgical results. J Korean Neurosurg Soc. 2005;38(3):196-201.
7. Lee DS, Park KS, Park MS. The comparative analysis of clinical characteristics and surgical results between the upper and lower lumbar disc herniations. J Korean Neurosurg Soc. 2013;54(5):379-83. http:// dx.doi.org/10.3340/jkns.2013.54.5.379. PMid:24379943.
8. Hsu K, Zucherman J, Shea W, et al. High lumbar disc degeneration. Incidence and etiology. Spine. 1990;15(7):679-82. http://dx.doi. org/10.1097/00007632-199007000-00012. PMid:2218715.
9. Karaaslan B, Aslan A, Borcek AO, Kaymaz M. Clinical and surgical outcomes of upper lumbar disc herniations: a retrospective study. Turk J Med Sci. 2017;47(4):1157-60. http://dx.doi.org/10.3906/sag-1604-113. PMid:29156856.
10. Aitken RCB. Measurement of feelings using visual analogue scales. Proc R Soc Med. 1969;62(10):989-93. http://dx.doi. org/10.1177/003591576906201005. PMid:4899510.
11. Fritz JM, Irrgang JJ. A comparison of a modified Oswestry Low Back Pain Disability Questionnaire and the Quebec Back Pain Disability Scale. Phys Ther. 2001;81(2):776-88. http://dx.doi.org/10.1093/ptj/81.2.776. PMid:11175676.
12. Kim DS, Lee JK, Jang JW, Ko BS, Lee JH, Kim SH. Clinical features and treatments of upper lumbar disc herniations. J Korean Neurosurg Soc. 2010;48(2):119-24. http://dx.doi.org/10.3340/jkns.2010.48.2.119. PMid:20856659.
13. Fontanesi G, Tartaglia I, Cavazzuti A, Giancecchi F. Prolapsed intervertebral disc at the upper lumbar level. Diagnostic difficulties. A report on 12 cases. Ital J Orthop Traumatol. 1987;13(4):501-7. PMid:3503877.
14. Fairbank J, Hashimoto R, Dailey A, Patel AA, Dettori JR. Does patient history and physical examination predict MRI proven cauda equina syndrome? Evid Based Spine Care J. 2011;2(4):27-33. http:// dx.doi.org/10.1055/s-0031-1274754. PMid:23230403.
15. Gardner A, Gardner E, Morley T. Cauda equina syndrome: a review of the current clinical and medico-legal position. Eur Spine J. 2011;20(5):690-7. http://dx.doi.org/10.1007/s00586-010-1668-3. PMid:21193933.
1 MD, Department of Neurosurgery, Giresun Education and Research Hospital, University of Giresun Medical School, Giresun, Turkey.
2 MD, Department of Neurosurgery, Giresun Education and Research Hospital, Giresun, Turkey.
3 MD, PhD, Department of Orthopedics and Traumatology, Giresun Education and Research Hospital, Giresun University Faculty of Medicine, Giresun, Turkey.
4 MD, Department of Neurosurgery, Trabzon Kanuni Education and Research Hospital, Trabzon, Turkey.
Received Nov 29, 2022
Corrected Dec 29, 2022
Accepted Jan 13, 2023
