Treatment of upper lumbar disc herniation by using posterior dural incision

Objective To study clinical efficacy of posterior dural incision and discectomy for single gap upper lumbar disc herniation.Methods There were 35 cases of single gap upper lumbar disc herniation,including 13 cases of lumbar 2-3,and 22 cases of lumbar 3-4.All patients were divided into two groups.Sixty cases were subjected to posterior dural incision and discectomy,followed by posterolateral fusion surgery (group A),and 19 cases to discectomy,followed by intervertebral fusion and internal fixation (group B).Blood loss and operative time during operation were observed.During the postoperative average follow-up period of 2 years and 4 months,the Japanese Orthopaedic Association (JOA) score and oswestry disability index (ODI) were assessed.Results The amount of blood loss during operation in group A and group B was 150-340 ml (mean 253 ml) and 320-670 ml (478 ml) respectively.The operative time in group A and group B was 75-125 min (mean 93 min) and 105-165 min (mean 137 min).There were significant differences in JOA score (10.30 ±2.27 vs.24.10 ± 1.26) score and ODI [(54.31 ± 11.07)％vs.(18.27 ± 5.81) ％] before operation and after the final follow-up in group A (P ＜ 0.05).There were significant differences in JOA score (10.60 ±2.33 vs.24.50 ± 1.25) and ODI [(53.93 ± 10.46)％ vs.(18.02 ± 5.78) ％] before operation and after the final follow-up in group B (P ＜0.05).However,there was no statistically significant difference in the follow-up intervals between group A and group B (P ＞ 0.05).Conclusion Posterior dural incision is an effective method for the treatment of upper lumbar disc herniation. Key words: Upper lumbar disc herniation;  Dural incision;  Internal fusion