| Lumbar disc herniation is very common in spine diseases. Review ofliterature showed that most lumbar disc herniations are found in the lowerlevels. Disc herniations at the T12/L1、L1/2、L2/3、L3/4levels were reportedin less than1%～5%of the cases.Unlike lower lumbar disc herniation’s typical symptom is ‘sciatica’, thesymptoms of upper lumbar disc herniation are various because it usuallyconsists of a compact neural component and conus medullaris in the dural sac.There is no so-called classic symptom for upper lumbar disc herniation, thesymptoms can be varies, such as femoral nerve involvement, sciatica andcauda equine syndrome. So it is easy to be misdiagnosed.Few articles focus on upper lumbar disc herniation. The MRI scan hasallowed visualization of early degenerative changes within the discs as well asadvanced structural changes. By reviewing consecutive MRI scans of patientswith back and/or leg pain, the authors showed that the incidence of upperlumbar disc herniation and degeneration is more common than previouslybelieved and extrapolated that altered mechanics may be associated with theseupper lumbar disc lesions.Upper lumbar disc degeneration or herniation are often associated withpre-existing or coexisting abnormalities which include Scheuermann’s diseaseand end-plate defects, compression deformity of the vertebral body,retrolisthesis and a limbus vertebra, previous fractures. Unlike the patientswith lower lumbar disc herniations are mostly senior people, the patients withhigh lumbar disc herniations are relatively young.Thoracolumar spine is the most popular lesion of spinal fracture.Compression fracture is the most popular type of fracture. Wedge-shaped vertebra can change the mechanics of adjacent levels by increasing the angleof superior endplate tilt. the composite mass of the superior vertebral levels,head and arms may translate slightly anteriorly. The moment arm distancebetween the vertebral centroid and composite centre of mass of the trunk willincrease, thereby increasing the flexion moment at that level, and contiguouslevels. As a result shear forces were greater at the level of WSV and one levelabove, while compression forces were greater at one level below WSVcompared to equivalent level mean forces of the non-fracture group.Based on the above theory we suggested to evaluate the force ofwedge-shaped vertebra, to compare the Cobb angles of high lumbar discherniation’s adjacent vertebra, in order to prove the relationship between highlumbar disc herniation and adjacent wedge-shaped vertebra, and to evaluatethe outcome of different surgery and treatment.Part1The biomechanical influence of wedge-shaped vertebra to adjacentdisc in goatsObjective: The purpose of this study was to compare the biomechanicalinfluence around normal vertebra and wedge-shaped vertebra of goatsMethods: Twenty fresh frozen thoracolumbar goat spine samples(T12-L2)were used for the test. The samples were randomly distributed into studygroup and control group. The L1vertebra bodies’ of the study group wereundergone osteotomy and fixation in order to make the wedge-shaped vertebramodel. Each model was successively loaded using an increasing axial force(200N,400N，800N), analyze the difference of the inner pressure of discs.Results: No significantly change was detected in our study group andcontrol group during200N loading, while after using the400N load,significantly difference was found between the two groups, the wedge-shapedgroup has higher inner pressure than control group,.Conclusion: our study showed the discs adjacent to the wedge-shapedvertebra have the tend to degenerate faster than the discs adjacent to thenormal vertebra. Part2Correlative Analysis of Isolated Upper Lumbar Disc Herniationand Adjacent Wedge-shaped VertebraeObjective: To study the relationship between isolated upper lumbar discherniation and adjacent wedge-shaped vertebrae.Methods: From January2003to0ctobor2012,47patients (27males and20females; mean age,41.2±5.6years) with single-level upper lumbar discherniation and47sex and age-matched asymptomatic healthy control subjectswere studied by radiograph. Age, body mess index and kyphotic angle of theobjective vertebrae were compared.Results: Average kyphotic angle in the study group was found to be11o(4-22o), meanwhile average kyphotic angle in the control group was2o (0-7o).The kyphotic angles of the study group were statistically significantly largerthan those of the control group (P<0.05). The correlations between the age andkyphotic angles, body mess index and the kyphotic angles in the study groupand the control group were uncorrelated or low correlated (Pearson’scorrelation coefficient:-0.146,-0.004,0.049,0.185)Conclusions: Wedge-shaped vertebrae are closely associated withadjacent upper lumbar disc herniation. When wedge-shaped vertebrae werelocated and accompanied with symptoms, upper lumbar disc herniation shouldbe alerted.Part3The comparison for different treatment for upper lumbar discherniationObjective: to evaluate the outcomes of different treatment for upperlumbar disc herniationMethods: From January2003to0ctobor2012,47patients (27males and20females; mean age,41.2±5.6years) with single-level upper lumbar discherniation were undergone the operation treatment, the patients were randomlydistributed into anterior operation group (13case), transforaminal lumbarinterbody fusion (TLIF) group (20cases) and discectomy group (14cases).The age, sex, body mess index, instability of lumbar and rate of fusion werecompared in all3groups. The VAS score were compared before and after operation. There was no removement of hardware.Results: All of the cases were followed12-50months (mean25.6±5.4months) after operation. There was no significant difference between thegeneral parameters of cases’ age, sex, body mess index. The operation timeand blood loss of the posterior operation group were significantly lower thananterior group. All of the cases for fusion operation were fused. The anteriorgroup has more complications than other groups. There was significantdifference between the VAS improvement rate, the discectomy group was thelowest.Conclusion: all of the three operation methods can achieve thedecompression aim for upper lumbar disc herniation. But the anterior group’sshortcoming is longer operation time and more blood loss. The stronghardware fixation can help patients get up early and get better treatmentoutcome. |
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