Discectomy for primary and recurrent prolapse of lumbar intervertebral discs (original) (raw)
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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.
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.
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.
Pancham Prasad & Parvinder Singh Sandhu., Sch Acad J Biosci, Nov, 2020; 8(11): 350-355, 2020
Background: Most common source of lower back pain is degeneration of intervertebral space leading to degenerative disc disease and lumbar herniation. We have various practices in India that include bending and twisting of the spine, making up for a strong case to study in detail about various causes of lumbar disc disease in patients coming to a tertiary center for treatment. Material and method: A hospital based study was conducted after clearance from IEC Dr. Hardas Singh orthopedic hospital and superspeciality research centre in from Jan 2019 till Feb 2020. Data were collected on structured questionnaire according to the set inclusion criterion for willing and consenting patients. Results: In our study we had 58 participants having more than 85% males with mean age of 23.45. Most of the patients were treated conservatively with excellent results. Conclusion: More large sample size is needed to come at any conclusion while like other published results we too saw that in most cases with age conservative management is a successful approach.
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.
2021
Background: Lumbar disc herniation is the most common cause of low back pain and significant disability with economic impact too. Management of disc herniation is challenging, often confusing when surgical treatment is considered, because of frequent failures after surgery in many patients to relieve symptoms. In the current study, we aimed to compare the functional outcomes of treating PIVD with discectomy alone and discectomy associated with posterior lumbar interbody fusion (PLIF).Materials and Methods: This study is randomised control study was conducted over 36 patients diagnosed with PIVD and operated for Discectomy (18 patients) or PLIF (18 patients) in Orthopaedic department, Geetanjali Medical College, Udaipur, Rajasthan between January 2019 to June 2020 and randomly allotted in two groups.To evaluate Functional outcomes using Japanese orthopedic score (JOA) and kirkaldy-willis criteria in every follow up at 2 week, 6 week, 3 month and 6 month.Results: Calculating the funct...
Background: A variety of minimally invasive techniques (chemonucleolysis, laser, automated percutaneous discectomy, percutaneous manual nucleotomy) have been invented over the years, as treatment of low back pain related to disc disease. Automated percutaneous lumbar dissectomy (APLD), being one of these techniques, is a modality in which removal of nucleus pulposus, reduces intradiscal pressure thus relieves the nerve root compression and subsequently reduces radicular pain. This technique was introduced by Onik in 1985, referred to as 'automated' since it involves a mechanical probe, working by a 'suction and cutting action for removal of the nucleus pulposus.
Risk Factors of Prolapse Lumbar Intervertebral Disc (PLID): A Synthesis of Short Review
2022
Introduction: LDH, defined as the localized displacement of disc material beyond the margins of the intervertebral disc space is considered the most common cause of lumbosacral radiculopathy. Compared with nonspecific low back pain without radiating leg pain, LDH is associated with radiating pain/ radiculopathy,severe pain, disability, healthcare use and intervention. Objectives: To explorethe risk-factors associated with PLID/ LDH. Literature: In this review, best evidence synthesis included systemic reviews, cohort studies and case-control studies that investigated the risk factors for LDH/ PLID. Critiques: LDH with radiculopathy results from complex relationships between individual, behavioural, and work-related variables. Evidence revealed that-age, sex, education, BMI, cardiovascular risk factors, smoking, occupational lumbar load by forward bending postures and manual materials handling, perceived risk of work injury, decision freedom at work, regular or irregular three-shift work or regular night work in and time pressure at work are associated with the development. It is also found that manual occupation, genetics, and previous back pain may contribute to the development of LDH with radiculopathy in adults. Conclusion: Although the literature is varying quality and heterogeneous, but the evidence revealed that LDH/ PLID is an important source of pain and disability in society. Future research should focus on prospective designs examining modifiable risk factors and prevention strategies.
2017
Background: Backache is second most common problem presenting to the primary healthcare providers. Lumbar discectomy has been revolutionized from open conventional discectomy to endoscopic removal. Endoscopic procedures are proving their superiority regarding good outcome, less wound site pain and shorter hospital stay, in Neurosurgery as well. Micro discectomy and Endoscopic discectomy is used only in few centres in Pakistan. This study aimed to share our experience of early surgical outcome endoscopic lumbar discectomy in terms postoperative pain improvement and duration of hospital stay Methods: This prospective study was carried out at Neurosurgery Department, Jinnah Hospital, Lahore from Jan 2014 to Jan 2016. During this period, 35 patients of both sexes, aging between 20 and 60 years, with symptoms and signs of lumbago with sciatica were enrolled. Data was collected on a questionnaire after informed verbal and written consent. Results: A total of 35 patients were operated incl...