Decompression alone for 62 isolated L1-2 lumbar disc herniation

Background: Upper lumbar disc herniations (ULDHs) are rare and present significant technical challenges due to the inability to retract the conus medullaris. Here, we reviewed our outcomes treating 62 patients with L1-2-disc herniations with open laminectomy/microdiscectomy (OLM) without fusion. Methods: Between 2005 and 2022, we performed 62 OLM procedures at the L1-2 level without fusion. Our analysis included demographic characteristics and outcomes assessments (Visual Analog Scale leg pain, Modified Japanese Orthopaedic Association score), plus 1-year postoperative dynamic X-rays to confirm stability. Results: L1-2-disc herniations occurred in 0.9% out of a larger series of lumbar discs we reviewed. Patients' presenting symptoms typically included back (95%)/leg pain (82%), cauda equina symptoms/signs (64%), and neurogenic claudication (45%); more than 50% of patients had been symptomatic for over 1 year. Postoperatively, no discs recurred, and patients exhibited neither clinical nor radiological symptoms/signs of instability. Conclusion: The OLM technique for removal of L1-2 lumbar disc herniations resulted in adequate outcomes without evidence of spinal instability.