Publication: Üst seviye lomber disk hernileri
Abstract
Amaç: Üst seviye lomber disk hernisi, klinik bulgular ve cerrahi özellikler bakımından nadir ve özellikli bir patolojidir. Bu çalışmada, üst seviye disk hernilerinin karakteristik özelliklerinin vurgulanması amaçlanmaktadır. Yöntem: Çalışma, klinik prospektif bir çalışmadır ve kliniğimizde L1-2 ve L2-3 disk hernisi nedeniyle opere edilen toplam 73 olgu çalışmaya dahil edilmiştir. Tüm olguların radyolojik görüntülemeleri (MRG, BT ve röntgenogram), yakınma ve nörolojik muayene bulguları kayıt edilmiştir. Olguların operasyon öncesi ve sonrası Vizüel Analog Skala (VAS) skorları sorgulanmıştır. Preoperatif dönemdeki radyolojik incelemelerde, operasyona hedef oluşturan herniyasyona ek olarak, skolyozun olup olmaması ve alt seviyelerde olası disk herniyasyonu, spondilolistezis, disk mesafesinde daralma ve disk dejenerasyonunun varlığı araştırılmıştır. Bulgular: Olguların cerrahi tedavisi sonrasında, VAS skorunda önemli iyileşme saptanmıştır. Üst seviye lomber disk hernili olgularda, karakteristik muayene bulgularının (femoral germe testi, his kusurunun dağılımı) olduğu görülmüştür. Radyolojik incelemelerde, disk herniyasyonuna eşlik eden komşu segment patolojileri saptanmıştır (disk dejenerasyonu, lordoz kaybı, skolyoz, instabilite). Cerrahi tedavide enstrümantasyon uygulanma oranı, L1-2 ve L2-3 disk hernili olgularda sırasıyla % 26 (n=5) ve % 24 (n=13)’tür. Çıkarımlar: Üst seviye lomber disk hernileri, alt seviye disk hernilerinden çok daha nadir görülmekte ve farklı özellikler taşımaktadır. Femoral germe testi, bu olguların muayenesinde çok değerlidir. Üst seviye disk hernilerine sıklıkla komşu segment patolojileri eşlik eder. Cerrahi tedavi sonrasında VAS skorlarında önemli iyileşme görülür.
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. Key words: Lumbar disc herniation, lumbar upper level disc, femoral stretching test
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. Key words: Lumbar disc herniation, lumbar upper level disc, femoral stretching test