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Herniation Level Affects Operative Treatment Outcomes

Benefits of lumbar discectomy are greatest for patients with herniations at higher lumbar levels

FRIDAY, Sept. 5 (HealthDay News) -- In patients with lumbar disc herniations, the herniation level has a significant effect on the outcomes of operative and non-operative care, according to research published in the September issue of the Journal of Bone & Joint Surgery.

Jon D. Lurie, M.D., of the Dartmouth Medical School in Lebanon, N.H., and colleagues compared outcomes in 646 L5-S1 herniations, 456 L4-L5 herniations, 68 L3-L4 herniations and 20 L2-L3 herniations, 415 of which were managed non-operatively.

The researchers found that the advantage of lumbar discectomy compared to non-operative treatment was greatest for herniations at L2-L3 and L3-L4, intermediate for herniations at L4-L5, and lowest for herniations at L5-S1. They also found that the magnitude of the difference between the upper-level herniations and herniations at L5-S1 was in the range of 10 to 15 points on the Short Form-36 bodily pain and physical functioning scales and the Oswestry Disability Index.

"There are several possible explanations for these findings," the authors write. "A number of studies have shown that reduced spinal canal cross-sectional area is associated with an increased probability of symptomatic disc herniation and greater intensity of herniation symptoms. The spinal cross-sectional area is the smallest at the most cranial lumbar segment and increases caudally. The smaller canal area at upper levels may contribute to the observed outcomes differences, but further analysis comparing outcomes to cross-sectional area is required."

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