1
|
Erdoğan U. The Results of Using a Transforaminal Lumbar Interbody Fusion Cage at the Upper Lumbar Level. Cureus 2021; 13:e15496. [PMID: 34268027 PMCID: PMC8262652 DOI: 10.7759/cureus.15496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 12/04/2022] Open
Abstract
Aim The aim of this study is to apply surgical treatments to upper lumbar disc hernias in order to provide lumbar stability and lumbar lordosis using a transforaminal lumbar interbody fusion (TLIF) cage and to preserve the success rate of surgical results by protecting neural structures without excessive subject tension. Material and methods Between 2012 and 2017, 32 patients who had undergone an operation for upper lumbar disc herniation and who had received a transforaminal lumbar interbody fusion cage using a posterior technique were evaluated retrospectively. Results The radiological and clinical findings, surgical methods, and results of the patients were evaluated. In our study, 25 (78.1%) of the patients with upper lumbar disc hernias who were evaluated retrospectively were female and seven (21.9%) were male. Their average age was 55.43 years. The average follow-up was 21.75 months. The most common complaints were lower back pain, leg pain, and claudication. In the findings from neurological examinations, a positive result on the femoral stretching test occurred in 30 (93.7%) patients. In the degenerative spinal structure of patients at the L1-2 and L2-3 levels, a transforaminal lumbar interbody fusion was performed via a wide laminectomy with posterior stabilization due to a wide-bottomed disc hernia and stenosis. Only one of the patients with a neurological deficit still had a motor deficit after surgery. Conclusion While planning a surgery for upper lumbar disc hernias, the anatomical features of this region and the patients' radiological and neurological findings should be carefully evaluated. If TLIF is performed during upper lumbar region surgery, it may be preferable to perform it using a posterior technique.
Collapse
Affiliation(s)
- Uzay Erdoğan
- Neurosurgery, University of Health Sciences, Bakırköy Prof. Dr. Mazhar Osman Training and Research Hospital for Neurology, Neurosurgery and Psychiatry, Istanbul, TUR
| |
Collapse
|
2
|
Chen J, Ni HJ, Xue F, Fan YS, Li XF, Chen XZ, He SS. Upper Lumbar Intradural Disc Herniation: A Rare Case Report and Etiologic Analysis. J Pain Res 2021; 14:1475-1481. [PMID: 34079362 PMCID: PMC8166278 DOI: 10.2147/jpr.s297304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 04/30/2021] [Indexed: 01/15/2023] Open
Abstract
Background Intradural disc herniation (IDH) is a rare type of disc degeneration that infrequently affects the upper lumbar spine. Pre- and intraoperative diagnosis and surgical management of IDH are challenging. The present case study provides insight into these aspects of upper lumbar IDH and discusses possible mechanisms. Case Description A 63-year-old female with a history of chronic lower back and leg pain presented with an acute lumbar sprain that had occurred 1 month prior. The pain progressed and spread to the front of the left thigh, which affected her ability to lift her leg when ascending/descending stairs. Sagittal gadolinium-enhanced magnetic resonance imaging (MRI) revealed a disc protruding into the ventral dural sac showing a hawk-beak sign, and the posterior edge of the disc annulus and local posterior longitudinal ligament was broken. Total L2 laminectomy was performed, and the dorsal side of the dural sac was exposed and incised to enable exploration of the ventral side of the dura. We found two free fragments protruding into the inner wall of the dura through the left ventral dura mater defect. After carefully and completely removing the mass, we repaired the defect and performed internal fixation. Postoperative pathologic analysis confirmed that the mass was nucleus pulposus tissue from the degenerated disc. The patient’s pain significantly improved after surgery, and she was able to walk normally at the 1-month follow-up. Conclusion Upper lumbar IDH is an extremely rare type of disc degeneration. An enhanced MRI scan can provide diagnostic evidence, but the final diagnosis requires surgical exploration of the path of herniation and pathologic examination of the mass lesion.
Collapse
Affiliation(s)
- Jia Chen
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, People's Republic of China.,Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, 200072, People's Republic of China
| | - Hai-Jian Ni
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, People's Republic of China.,Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, 200072, People's Republic of China
| | - Fei Xue
- Department of Neurosurgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, People's Republic of China
| | - Yun-Shan Fan
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, People's Republic of China.,Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, 200072, People's Republic of China
| | - Xi-Fan Li
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, People's Republic of China
| | - Xian-Zhen Chen
- Department of Neurosurgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, People's Republic of China
| | - Shi-Sheng He
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, People's Republic of China.,Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, 200072, People's Republic of China
| |
Collapse
|