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Comparative Study
. 2024 Jun 15;25(1):470.
doi: 10.1186/s12891-024-07588-7.

Percutaneous transforaminal endoscopic discectomy for Upper Lumbar Disc Herniation versus lower lumbar disc herniation: clinical outcomes and technical consideration

Shuo Yuan #  1 , Yuqi Mei #  1 , Lei Zang  2 , Xuanyu Lu  1 , Ning Fan  1 , Peng Du  1
Affiliations
Comparative Study

Percutaneous transforaminal endoscopic discectomy for Upper Lumbar Disc Herniation versus lower lumbar disc herniation: clinical outcomes and technical consideration

Shuo Yuan et al. BMC Musculoskelet Disord. .

Abstract

Background: Upper lumbar disc herniation (ULDH) accounts for 1-10% of all lumbar disc herniations (LDH). This study aimed to evaluate the clinical characteristics and outcomes of patients with ULDH who underwent percutaneous transforaminal endoscopic discectomy (PTED) compared with those with lower LDH.

Methods: 60 patients with ULDH or L4-L5 LDH treated with PTED between May 2016 and October 2021. MacNab criteria, visual analog scale (VAS) of back pain and leg pain, and Japanese Orthopedic Association (JOA) were evaluated before and after surgery.

Results: In the L1-L3 group, 59.1% of the patients had a positive femoral nerve tension test, and 81.8% of the patients had a sensory deficit. Both groups showed significant improvements in VAS scores for low back and leg pain, and JOA scores postoperatively. No significant differences in the degree of improvement were observed between the two groups. The excellent/good rate was 81.8% in the L1-L3 group and 84.2% in the L4-L5 group, showing no significant difference.

Conclusion: PTED has comparable efficacy in treating ULDH as it does in treating lower LDH, it is a safe and effective treatment method for ULDH.

Keywords: Discectomy; Percutaneous transforaminal endoscopic discectomy; Treatment outcomes; Upper lumbar disc herniation.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Images from a typical case of percutaneous endoscopic transforaminal discectomy in a 74-year-old female with upper lumbar disc herniation at L2–3. (a) Preoperative axial CT. (b, c, d) Preoperative sagittal and axial T2-weighted MRI shows the left side lumbar disc herniation at L2–3. (e) Postoperative axial CT shows partial removal of the superior articular process. (f, g, h) Postoperative sagittal and axial T2-weighted MRI illustrates complete excision of the prolapsed disc, without residual disc at L2–3
Fig. 2
Fig. 2
Intraoperative view of the L3 nerve root after decompression. The black arrow indicates the L3 nerve root
See this image and copyright information in PMC

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