Aim:

Upper level lumbar disc herniation is a rare and characteristic entity in means of surgical features and clinical symptoms. This is a prospective study which aims to delineate the distinctive properties of upper level lumbar disc herniations.

Methods:

In a prospective clinic study, 73 patients operated in our clinic for L1-2 and L2-3 disc herniations were enrolled. The radiologic examinations (MRI, CT and x-ray), complaints and neurological examinations were recorded for all cases. Preoperative and postoperative Visual Analogue Scale (VAS) scores were investigated. Preoperative radiologic exams were interpreted for lumbar pathologies accompanying disc herniation such as scoliosis, lower level disc herniations, loss of disc height, spondylolysthesis and disc degeneration.

Results:

At postoperative period, a noticeable improvement was recorded in VAS scores. Neurologic examination of patients with upper level disc herniations revealed some distinctive findings (femoral stretching test, distribution of hypoesthesia). Radiological evaluation revealed adjacent segment pathologies accompanying upper level disc herniations (disc degeneration, loss of lordosis, scoliosis and instability). The rate of instrumentation for L1-2 and L2-3 disc herniations were 26% (n=5) and 24% (n=13) respectively.

Conclusions:

Upper level lumbar disc herniations are much less frequent than lower level disc herniations and they have different features. Femoral stretching test is valuable in the neurological examination of these cases. Upper level disc herniations are often accompanied by adjacent segment pathologies. Surgery leads to significant improvement in VAS scores.

Keywords: Lumbar disc herniation, lumbar upper level disc, femoral stretching test