- Volume 28 Issue 4
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Comparative Study on the Clinical Characteristics and Effects of Korean Medical Treatment between the Upper and Lower Lumbar Single Level Disc Herniation
상부요추와 하부요추 단분절 추간판 탈출증 환자의 임상적 특성과 한방치료 효과 비교연구
- Lee, Ju-Young ;
- Kim, Yong-Hyeon ;
- Kim, Kwang-Hwi ;
- Kim, Tae-Yeon ;
- Lee, Tae-Geol ;
- Lee, Sang-Woon ;
- Chu, Hui-Yeong ;
- Jung, Hui-Kyeong ;
- Jung, Bum-Hwan
- Received : 2018.09.14
- Accepted : 2018.10.08
- Published : 2018.10.31
Objectives Upper lumbar disc herniation (LDH) (L1/2, L2/3) has specific anatomical characteristics and different outcome after conventional treatment compared to lower LDH (L3/4, L4/5, L5/S1). The purpose of this study was to compare the clinical features and effects of korean medical treatment of upper LDH between lower LDH. Methods We retrospectively reviewed the clinical data collected from 121 patients who was had admitted at the Haeundae Jaseng Hospital of Korean Medicine from June 1st, 2014 to August 31th, 2018. The patients who had treated at L1/2, L2/3 level LDH were grouped and compared with those treated at the L3/4, L4/5, L5/S1 level. We reviewed the patient characteristics such as age, the positive rate of Straight Leg Raise Test (SLR test), the presence or absence of previous lumbar surgery. Numeric Rating Scale (NRS) and Oswestry Disability Index (ODI) were evaluated at adimission and discharge. Results Mean age was significantly higher at upper LDH group and positive rate of SLR test was higher at lower LDH group. There was no significant difference of gender and previous lumbar surgery between two groups. Each group had a significant improvement of NRS, ODI scores. But between two groups, there was no significant difference of NRS, ODI scores. Conclusions Upper LDH group was older than lower LDH group. SLR test was useful tool to exclude upper LDH. Korean medical treatment was significantly effective to both upper and lower LDH groups. Further well designed prospective comparative studies are needed.
Intervertebral disc disease;Lumbar vertebrae;Korean Traditional Medicine
- Saberi H, Isfahani AV. Higher preoperative Oswestry disability index is associated with better surgical outcome in upper lumbar disc herniations. European Spine Journal. 2008;17(1):117-21. https://doi.org/10.1007/s00586-007-0527-3
- Lee SH, Choi SM. L1-2 Disc herniations: clinical characterisitcs and surgical results. Journal of Korean Neurosurgical Society. 2005;38(3):196-201.
- Pasztor E, Szarvas I. Herniation of the upper lumbar discs. Neurosurgical Review. 1981;4(3):151-7. https://doi.org/10.1007/BF01743641
- Hsu K, Zucherman J, Shea W, KaiserJ, White A, Schofferman J, Amelon C. High lumbar disc degeneration incidence and etiology. Spine (Phila Pa 1976). 1990;15(7):679-82. https://doi.org/10.1097/00007632-199007000-00012
- Nadler SF, Campagnolo DI, Tomaio AC, Stitik TP. High lumbar disc: diagnostic and treatment dilemma. American Journal of Physical Medicine and Rehabilitation. 1998;77(6):538-44. https://doi.org/10.1097/00002060-199811000-00018
- Wu J, Zhang C, Zheng W, Hong CS, Li C, Zhou Y. Analysis of the characteristics and clinical outcomes of percutaneous endoscopic lumbar discectomy for upper lumbar disc herniation. World Neurosurgery. 2016;92:142-7. https://doi.org/10.1016/j.wneu.2016.04.127
- Shin DE, Ahn CS, Cho DY, Yoon HK, Kim TH, Bang JY, Cha YS. Herniation of upper lumbar disc-clincal finding and surgical result-. Journal of Korean Society of Spine Surgery. 2012;19(3):103-9. https://doi.org/10.4184/jkss.2012.19.3.103
- Chang HG, Lee YG. Natural history and clinical manifestations of lumbar disc herniation. Journal of Korean Society of Spine Surgery. 2001;8(3):305-13. https://doi.org/10.4184/jkss.2001.8.3.305
- Albert TJ, Balderston RA, Heller JG, Tomany K, Heller JG, Herkowitz HN, Garfin SR, An HS, Simeone FA. Upper lumbar disc herniations. Journal of Spinal Disorders. 1993;6(4):351-9. https://doi.org/10.1097/00002517-199306040-00009
- Kido T, Okuyama K, Chiba M, Sasaki H, Seki N, Kamo K, Miyakoshi N, Shimada Y. Clinical diagnosis of upper lumbar disc herniation: pain and/or numbness distribution are more useful for appropriate level diagnosis. Journal of Orthopaedic Science. 2016;21(4):419-24. https://doi.org/10.1016/j.jos.2016.03.003
- Sanderson SP, Houten J, Errico T, Forshaw D, Bauman J, Cooper PR. The unique characteristics of "upper" lumbar disc herniations. Neorosurgery. 2004;55(2):385-9. https://doi.org/10.1227/01.NEU.0000129548.14898.9B
- Lee DS, Park KS, Park MS. The comparative analysis of clinical characteristics and surgical results between the upper and lower lumbar disc herniations. Journal of Korean Neurosurgical Society. 2013;54(5):379-83. https://doi.org/10.3340/jkns.2013.54.5.379
- Kim DS, Lee JK, Jang JW, Ko BS, Lee JH, Kim SH. Clinical features and treatments of upper lumbar disc herniations. Journal of Korean Neurosurgical Society. 2010;48(2):119-24. https://doi.org/10.3340/jkns.2010.48.2.119
- Iwasaki M, Akino M, Hida K, Yano S, Aoyama T, Saito H, Iwasaki Y. Clinical and radiographic characteristics of upper lumbar disc herniation: ten-year microsurgical experience. Neurologia Medico-Chirurgica (Tokyo). 2011;51(6):423-6. https://doi.org/10.2176/nmc.51.423
- Karaaslan B, Aslan A, Borcek AO, Kaymaz M. Clinical and surgical outcomes of upper lumbar disc herniations: a retrospective study. Turkish Journal of Medical Sciences. 2017;47(4):1157-60. https://doi.org/10.3906/sag-1604-113
- Korean Acupuncture and Moxibustion Medicine Society. Acupuncture and Moxibustion Medicine. 1st ed. Paju: Jipmoondang. 2012:200-1.
- Cho HJ, Sul JU, Shin MS. Research trends on the treatment of lumbar herniated intervertebral disc in Korean Medicine. Korean Journal of Acupuncture. 2012;29(4):501-18.
- Kim SN, Kim SC, Choi HK, So KS, Lim JA, Moon HC, Lee JD, Choi SY, Kim HH, Lee OJ. Clinical study on effect of scolopendrid aquacupuncture classified by the type of lumbar disc herniation. The Journal of Korean Acupuncture and Moxibustion Society. 2004;21(5):79-99.
- Shim SY, Park HJ, Lee JM, Lee HS. An overview of pain measurements. Korean Journal of Acupuncture. 2007; 24(2):77-97.
- Fairbank JCT, Davis J, Couper J, O'brien J. The Oswestry disability questionnaire. Physiotherapy. 1980;66(8):271-3.
- Van der Windt DA, Simons E, Riphagen II, Ammendolia C, Verhagen AP, Laslett M, Deville W, Deyo RA, Bouter LM, de Vet HC, Aertgeerts B. Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain. Cochrane Database Systemic Reviews. 2010:17(2):CD007431.
- Eom TW, Choo WJ, Lee CR, Kim HJ, Lee MJ. A study of the relationship between straight leg raising, Valsalva test and size, position of lumbar disc herniation. J Korean Med Rehabil. 2013:23(2):129-38.
- The Korean Orthpaedic Association. Orthopaedics. 6th ed. Seoul:ChoiSin medical Publishing Co. 2006:625.
- Knutsson B. Comparative value of electromyographic, myelographic and clinical neurological examination in diagnosis of lumbar root compression syndrome. Acta Orthp. 1961;32(1):3-135.
- Majlesi J. Togay H, Unalan H, Toprak S. The sensitivity and specificity of the slump and the straight leg raising tests in patients with lumbar disc herniation. Journal of Clinical Rheumatology. 2008;14(2):87-91. https://doi.org/10.1097/RHU.0b013e31816b2f99
- Shvartzman L, Weingarten E, Sherry H, Levin S, Persaud A. Cost- effectiveness analysis of extended conse-rvative therapy versus surgical intervention in the management of herniated lumbar intervertebral disc. Spine. 1992;17(2):176-82. https://doi.org/10.1097/00007632-199202000-00010
- Saal JA, Saal JS. Nonoperative treatment of herniated lumbar inter-vertebral disc with radiculopathy: an outcom study. Spine. 1989;14(4):431-7. https://doi.org/10.1097/00007632-198904000-00018
- Raymond WJG. Clinically important outcomes in low back pain. Best Practice and Research Clinical Rheumatology. 2005;19(4):593-607. https://doi.org/10.1016/j.berh.2005.03.003
- Ido K, Shimizu K, Tada H, Matsuda Y, Shikata J, Nakamura T. Considerations for surgical treatment of patients with upper lumbar disc herniations. Journal Spinal Disorder. 1998;11(1):75-9.
- Ahn Y, Lee SH, Lee JH, Kim JU, Liu WC. Transforaminal percutaneous endoscopic lumbar discectomy for upper lumbar disc herniation: clinical outcome, prognostic factors, and technical consideration. Acta Neurochirurgica (Wien). 2009;151(3):199-206. https://doi.org/10.1007/s00701-009-0204-x
- Moon KH, Lee SH, Kong BJ, Shin SW, Bhanot A, Kim DY, Lee HY. An oblique paraspinal approach for intracanalicular disc herniations of the upper lumbar spine: technical case report. Neurosurgery. 2006;59(4):487-8.