A Study to Assess the Functional Outcome After Laminotomy and Microdiscectomy in Lower Lumbar Disc Prolapse (original) (raw)
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Functional Outcome of Discectomy for Lumbar Disc Prolapse
Journal of Spine
Background: This study was to find out that whether the lumbar disc prolapse at different level influence the functional outcome of patients after discectomy. Present study is of 50 adult cases admitted at D. Y Patil Medical College. Common age group involved was between 40-60 years. Aims: To assess whether there is any difference in functional outcome of patients with disc prolapse at different levels in the lumbar spine after performing discectomy Objectives: To compare pre-operative and post-operative: • Leg pain and back pain by Visual Analog Scale Score • Functional outcome by Modified Oswestry Disability index score of the selected patients. Materials and methods: This study was a comparative study, conducted for a period of about two years, July 2014 to September 2016 in dr. D. Y. Patil Medical College, Hospital & Research Centre, only patients who were scrutinized for exclusion criteria and also abiding to inclusion criteria were included. Period required for data collection: 2 years. Period required for data analysis and reporting:-6 months. We prospectively followed 50 consecutive patients with unilateral lumbar herniation either at L2-L3, L3-L4, L4-L5 or L5-S1 levels requiring surgery. The procedure performed was Micro lumbar discectomy in all patients. Results: A total of 50 patients were included in our study of which 4 (8%) patients had prolapsed intervertebral disc at L2-L3 level and 10 (20%) patients had disc prolapsed at L3-L4 level. These 14 patients were included in upper lumbar level disc herniation group referred hereafter as Group 1 (28%). 22 (44%) patients had disc prolapsed at L4-L5 level and 14 (28%) patients had disc prolapsed at L5-S1 level, these 36 patients were included in lower lumbar level disc herniation group who are referred hereafter as Group 2 (72%). On comparing the results after discectomy of prolapsed intervertebral disc at different levels in the lumbar spine we found no significant difference in the end result and functional outcome of the patients. Conclusion: The aim of this study was to find out that whether the lumbar disc prolapse at different levels influence the functional outcome of patients. According to the observations of this study and after reviewing various similar studies done in the past we conclude that after discectomy, level of disc prolapse per se has no significant bearing on functional outcome of the patients.
Laminotomy Discectomy Versus Conservative Management for Lumbar Disc Prolapse: Short Term Results
Innovative Publication, 2016
Background & Objectives: Back pain, the ancient curse is now appearing as a modern epidemic. 80% of the population is affected by this symptom at sometime of life. Impairments of the back and spine are ranked as the most frequent cause of limitation of activities in people of all age groups. Lumbar discs are responsible for well over 90% of all organic symptoms attributable to low backache. Here we have done a clinical study, which includes sixty cases of lumbar intervertebral disc prolapse in the age group of 20 to 70 years, irrespective of sex, with clinical symptoms, signs and radiological evidence treated either conservatively or surgically with discectomy in the Department of Orthopaedics at our institute. All cases were followed up and functional results were analysed. The objective was to study the clinical presentation, evaluate outcome of both conservative and surgical management and to compare the results of both modes of treatment. Methods: Out of 60 patients included in the study, 30 were treated conservatively & another 30 underwent laminotomy discectomy in the Department of Orthopaedics at our institute between October 2007 & September 2013. The short-term follow-up results in patients who were followed up for a minimum of 6 months after treatment were evaluated by using the Japanese Orthopaedic Association scoring system through clinical examination and questionnaire. Results: Prevalence of disc prolapse was in age group of 20 to70 years, while peak incidence was between 30-40 years of age. Incidence of disc prolapse in males was almost twice as much as in females (in our series 65% male cases were noted). 56.67% cases had disc prolapse at L4-L5 level, which being the commonest site of disc prolapse followed by L5-S1 of about 41.67% and 1.67% at L3-L4 level. In the short term follow-up of 6 months, the outcome was good in 90% & excellent in 6.67% of surgically treated patients with 3% complication rate. Conservatively treated group of patients showed 46.67% good, 43.33% fair & 10% poor results. Interpretation & Conclusion: Short term outcome of standard discectomy in our study was favourable and comparable to other studies. With the execution of appropriate selection criteria and appropriate pre & post treatment planning, a good to excellent outcome was seen in nearly 97% in surgical study. In conservatively treated group, 90% patients showed fair to good result. Therefore lumbar discectomy is still a simple, safe & effective treatment with rapid relief for patient while conservative treatment if given to properly selected cases also gives effective results. Patients undergoing surgery for lumbar disc herniation achieved greater improvement in outcome than conservatively treated patients.
Functional outcome of discectomy in lumbar disc prolapse
International Journal of Orthopaedics Sciences, 2021
Background: Sciatica resulting from a lumbar intervertebral disc prolapse is the most common cause of radicular leg pain in adult working population. It can be treated with both conservative and operative methods. In our study, we have chosen open discectomy as an appropriate mode of surgical treatment for lumbar intervertebral disc prolapse. We assessed the surgical outcomes of patients treated with discectomy in lumbar disc prolapse. Objectives: To compare pre and post-operative back pain and leg pain using Visual Analogue Scale (VAS) and functional outcome using modified Oswestry Disability Index (ODI). Methods: 30 patients were included in this study and were followed up for up to 6 months postoperatively. We assessed the functional outcome of each patient with ODI and VAS post-operatively and at 6 months. Results: We found that males had higher incidence (60%) of disc prolapse. Majority of the patients presented with left sided radiculopathy (60%) and most commonly involving L4-L5 level (76.7%). The mean ODI and VAS score pre-operatively were 59.40±6.07 and 8 respectively, which improved to 15.12±5.15 and 1, respectively at 6 months post-operative follow-up. These were statistically highly significant. Conclusions: Our study established that open discectomy has a satisfactory functional outcome and leads to a significant improvement in the patients' quality of life.
Open Access Macedonian Journal of Medical Sciences, 2019
AIM: This work aims to compare between results of microdiscectomy and open discectomy in management of high-level lumbar disc prolapse. METHODS: This is a controlled randomised study, where patients having upper lumbar disc herniations were evaluated preoperatively both clinically and radiologically, randomisation was planned to perform open discectomy in odd number patients and to perform microdiscectomy in even number patients, patients were evaluated and followed up for deficits and outcomes. RESULTS: We operated ten patients in this study, five cases were operated upon with microdiscectomy, and five cases were operated upon with open discectomy, the median age of presentation in this study was 44 years, there were five males and five females, postoperative pain improvement was better in microdiscectomy. Hospital stay, blood loss, bone loss and postoperative complications were less in microdiscectomy. CONCLUSION: Microdiscectomy allows good surgical visualisation and is less trau...
Clinical profile of patients with lumbar disc prolapse
National Journal of Clinical Orthopaedics, 2021
The motion in the lumbar spine is divided between five motion segments, although a disproportionate amount of the motion is in the lower segments (L3-L4 and L4-L5). The two lowest discs (L4-L5 and L5-S1) take the most strain and are the most likely to herniate. This can cause lower back pain and possibly numbness that radiates through the leg and down to the foot (sciatica). Written informed consent for participation in the study was obtained from all the subjects. After the patient's informed consent was obtained, 150 patients with lumbar disc prolapse were subjected to epidural steroid infiltration out of which 101 underwent IL procedure and 49 underwent TF epidural steroid injections under the fluoroscopic guidance according to surgeons preference. As per my study out of the total 150 patients, 105(70%) improved in their symptoms only with epidural steroid and 45 patients (30%) proceeded to surgery, which was statistically significant.
Functional outcome of patients undergoing lumbar discectomy
International Journal of Research in Orthopaedics, 2018
Background: Sciatica resulting from a lumbar intervertebral disc herniation is the most common cause of radicular leg pain in adult working population. It can be treated with both conservative and operative methods. In our study, surgical treatment of lumbar disc prolapse has been done by open discectomy. We wish to assess the outcome of surgery in patients with lumbar disc prolapse undergoing lumbar discectomy. Methods: 40 patients were included in this study and were followed up for up to 1 year postoperatively. We assessed the outcome of each patient with ODI and VAS post-operatively and on follow-up at 3 weeks, 6 months and 1 year. Subjective evaluation of the patient's satisfaction at the final follow-up was also done. Results: We found that males had higher incidence of PIVD with an average duration of symptoms before surgery about 8.62 months. Left side was most involved and level l4-l5 was most involved level. The mean ODI and VAS score pre-operatively were 26.85±4.20 and 7.73±0.88 respectively, which changed to 4.48±5.15 and 1.70±1.57, respectively at 1 year post-operative follow-up. These were statistically highly significant. Most of the patients (34) gave a subjective evaluation as excellent at 1 year follow-up. Conclusions: Our study established that open discectomy has a satisfactory functional outcome and leads to a significant improvement in the patients' quality of life.
European Spine Journal, 2010
The aim of our study was twofold: firstly, to compare the preoperative and postoperative results at midterm follow-up periods along with the data of the control group. Secondly, to evaluate the effectiveness among opendiscectomy and microdiscectomy surgical groups. In the present study, we investigated a cohort of 100 patients with the lumbar disc herniation causing low back pain compared to 100 subjects of the control group with the non-specific low back pain by applying physical activity, pain scale, Short Form 36 General Health Questionnaire and additional postoperative records of patient's satisfaction and complications level, consumption of analgesics, and return to work status. The quantitative analysis of all questionnaires showed substantial differences in the preoperative and postoperative groups. The best results were achieved at the second year follow-up period. However, there were no statistically significant differences in both the examined surgical subgroups (p [ 0.05). In addition, we estimated from moderate to great statistical significance (p \ 0.01-0.05) among preoperative and overall postoperative results: PHC and MHC in the SF-36, Oswestry and VAS. The total increased satisfaction, reherniation rate and return to work frequency comprised 40, 9 and 64%, respectively. The analgesics were still indicated for 21% of the patients. The results of the present study suggest of sufficient decompression in both surgical groups, as the health-related quality of life parameters (Oswestry, VAS and SF-36) were defined as clinically improved. Regardless of persisted minor pain in both areas, it remained greater in the low back than in the leg, which should be held for beneficial to decompressive surgery.
International Journal of Orthopaedics Sciences, 2020
Background: Backache is a disease of antiquity and has tormented lives of innumerable individual of mankind. At some point during their lifetime, about 80% of adults can be expected to experience low backache. Its point prevalence is about 30%. By the age of 30 years, almost half of adults have experienced a substantive episode of low backache. Materials and Methods: 85 patients with lumbar prolapsed intervertebral disc where selected between April 2018 to April 2019 with taking inclusion and exclusion criteria into account. 42 patients were undergone conservative treatment, 26 patients were given epidural steroid injection, 17 patients were undergone surgical (discectomy) treatment. Observation in all three groups were analyzed and compared. Results: Patients were evaluated at post op 15 days, 1 month, 3 months and 6 months with respect to previous examination findings short term outcome over a period of six months, good (60-80% improvement in ODI) to excellent (> 80% improvement in ODI) outcome is seen in94% of surgically treated patients, whereas only 81% of patients treated with epidural steroid were to having good to excellent results but in conservatively treated group only 12% of patients had good to excellent outcome. Around 88% of conservatively treated patients had fair outcome. Conclusion: Short term outcome of discectomy for PIVD is favorable as compared to conservative treatment. Epidural steroid offers promise for temporary relief with many patient requiring repeat injections at variable time interval.
Evaluation of Minimal Invasive Fragmentectomy in Treatment of Lumbar Disc Prolapse
The Medical Journal of Cairo University
Background: Various surgical methods were described for treatment of lumbar disc prolapse including microdiscectomy, later sequestrectomy was described for preservation of disc height and minimalizing the surgical intervention. Aim of Study: The aim of this study is to evaluate the outcomes of lumbar disc fragmentectomy in patients with lumbar disc herniation in terms of pain (back pain and radicular) relief, improvement of neurological deficit if present, hospital stay duration, time consumed for return to work, and the incidence of complications with this intervention compared to conventional microdiscectomy. Patients and Methods: This is case series study, where patients having lumbar disc herniation were evaluated preoperatively both clinically and radiologically patients were operated by microfragmentectomy and followed-up conducted for 3 months for recurrence rate and outcomes. Results: We operated twenty cases in this study, with microfragmentectomy, the mean age of patients was 34.75 years, there were 15 males and 5 females, postoperative pain improvement was better in microfragmentectomy. Hospital stay, blood loss, and postoperative complications were less in microfragmentectomy. Conclusion: Microfragmentectomy allows good surgical visualization and is less traumatic to the involved tissues. The results of this study indicated that microfragmentectomy reduces hospitalization time, improves the overall surgery related outcome, microfragmentectomy allows patients earlier return to work and normal life with less reliance on postoperative narcotic analgesic agents.
Low-back pain following surgery for lumbar disc herniation. A prospective study
The Journal of bone and joint surgery. American volume, 2004
Lumbar disc herniation often causes sciatica. Although surgery may provide relief of sciatic pain, it is uncertain how surgery affects the relief of low-back pain. The purpose of the present prospective study was to assess the efficacy of discectomy in the treatment of low-back pain associated with lumbar disc herniation. Between 1998 and 2001, forty consecutive patients with single-level, unilateral lumbar disc herniation were treated surgically. The first twenty patients (Group 1) underwent standard discectomy, and the second twenty (Group 2) underwent microendoscopic discectomy. Curettage of the disc space was not performed. All forty patients were prospectively followed, and clinical outcomes were evaluated with use of a questionnaire. The mean duration of follow-up was forty months. All forty patients were satisfied with the outcome. Leg pain decreased rapidly (within one month) in all patients and continued to decrease at the time of the latest follow-up. There was no signific...