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Upper lumbar disc herniations

T J Albert1, R A Balderston, J G Heller

  • 1Thomas Jefferson University Hospital, Pennsylvania Hospital, Philadelphia.

Journal of Spinal Disorders
|August 1, 1993
PubMed
Summary

Diagnosing upper lumbar disc herniations (L1-2, L2-3, L3-4) is challenging due to variable symptoms and misleading tests. Combining myelography with CT/MRI and using intraoperative radiographs improves diagnosis and outcomes.

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Area of Science:

  • Neurosurgery
  • Orthopedic Surgery
  • Radiology

Background:

  • Upper lumbar disc herniations (L1-2, L2-3, L3-4) present unique diagnostic challenges.
  • Preoperative clinical presentation and neurological testing can be variable and misleading.

Purpose of the Study:

  • To review the presentation, diagnosis, and outcomes of surgically treated upper lumbar disc herniations.
  • To evaluate the effectiveness of various diagnostic imaging modalities for these conditions.

Main Methods:

  • Retrospective analysis of 141 patients who underwent surgery for upper lumbar disc herniations between 1980 and 1990.
  • Comparison of individual and combined radiographic studies (CT, myelography, MRI) against operative findings.
  • Assessment of operative complications and long-term patient outcomes via chart review.

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Main Results:

  • All diagnostic imaging modalities showed high false-negative rates when used individually, particularly for L2-3 herniations.
  • Intraoperative radiographs were increasingly utilized for higher lumbar levels.
  • Six operative complications (4.3%) occurred, with full recovery.
  • No reoperations or late complications were noted at an average 2.2-year follow-up.
  • Patients without compensation or legal claims had significantly better outcomes (86% good/excellent) than those with claims (45% good/excellent).

Conclusions:

  • A combination of myelography with postmyelogram CT and/or MRI is recommended for diagnosing upper lumbar disc herniations.
  • Intraoperative radiographs are crucial for all upper lumbar disc herniation decompressions.
  • Outcomes are significantly poorer for patients with compensation or pending legal claims.