The Analysis Of Diagnosis And Treatment Of The Upper Lumbar Disk Herniation

Part 1 Surgical treatment of upper lumbar intervertebral disc herniationObjective: To explore the clinical characteristics and surgical approaches of the upper lumbar disc herniation.Methods: This paper retrospectively studied 36 hospitalized patients with upper lumbar disk herniation from 2009 to 2013. The curative effect was evaluated by modified macnab standard. Data was quantified by ODI and VAS score standard and was analyzed by statistical software. The SUK standard and the computing method reported by Annette Kettler was used to evaluate the rate of fusion. Independent samples t-test was used as statistical methods.Results: Among all of the patients, there were 24 males and 12 females, with the average age of 55.4 years old(range, 37 to 66 years old). All the patients were followed up 11 to 43 months(average 24 months). 25 patients, including 11 cases of L1/2 and 14 cases of L2/3, were treated with Transforaminal Lumbar Interbody Fusion(TLIF). 11 cases of L2/3 were treated with Posterior Lumbar Interbody Fusion(PLIF). Therapeutic effect was evaluated by modified Macnab standard: there were 22 excellent cases, 8 good cases, 4 ordinary cases and 2 bad case. At the last follow-up, the average ODI and VAS were 20.62±4.72 、 2.02±0.74, which were better than that of pre-operation(51.22±4.61 、8.33±0.82), there is statistical significance(P<0.0001). The ODI and VAS score of patients who were treated with PLIF are worse than patients of TLIF, but there is no statistical significance between them. Among patients who were treated with PLIF, 6 cases got cerebrospinal fluid leakage, 2 cases got nerve root irritation, 1 case got defecation dysfunction. The x-rays and CT of the last follow-up for the patients showed that the intervertebral bone fusion rate was 100%. The postoperative lumbar lordosis Angle and relative intervertebral height had improved significantly than that of preoperation. Conclusion: As to upper lumbar disk herniation, the clinical manifestation is complicated, the lesion of nerve is relatively servere and misdiagnosis rate is high. Early decompression is the key of treatment. We propose that TLIF should but PLIF should not be used for upper lumbar disk herniation as there’s many complications for PLIF. Part 2 The comparative study of different segement of upper lumbar diskherniation-the significance of ODI in the treatment of lumbar disk herniationsObjective: To contrast ODI and Prolo score and investigate the definition of upper lumbar disk herniation and the clinical significance of ODI score in the treatment upper lumbar disk herniation.Methods: Select 24 patients with upper lumbar disk herniation(L1-L2 and L2-L3) as group A and 24 patients of L3-L4 as group B from patients with lumbar surgery in our hospital from 2008 to 2013. Preoperative and postoperative ODI and Prolo score after one year are recorded. The improvement of the ODI is used to evaluate the recovery of neural function.Results: There is statistical difference between the Prolo score of two groups, and the postoperative ODI has significantly increased than preoperative ODI for two groups(P<0.05). There’s significant statistical difference for the postoperative ODI and the improvement of the ODI of two groups(P<0.05). The postoperative ODI and Prolo differentied from each other and the rate of “Improved” was higher. High ODI score before surgery is significantly associated with bad postoperative functional recovery. In group A, 8.3% of the postoperative ODI score of patients increase, while the ODI of patients of group B is significantly reduced.Conclusion: The segement of L1-L2, L2-L3 and L3-L4 differ from each other on surgical curative effect. ODI score emphasizes on subjective symptom and functional improvement much more than Prolo and it is more sensitive to operative outcomes, so we recommend that it be used as an indicator to assess the neural functional recovery of patients with upper lumbar disk herniaion.