To evaluate outcomes of various managements in lumbar prolapsed intervertebral disc and factors affecting the outcomes (original) (raw)
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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.
International Journal of Advanced Research (IJAR), 2019
The intervertebral disc is subject to continuous and progressive degenerative changes through out life, L3,L4,L5 showing greatest degree of degeneration. This study aims to study the outcomes of use of a mixture of epidural steroid and local anaesthetic in cases of IVDP. 20 cases of IVDP were treated with above mentioned method. Clinical results were analysed at the end of 4, 6, 8 and 12 weeks. The parameters assessed during each visit are: improvement in symptoms like, backache, sciatica, ability of carrying out daily activities, lifestyle, walking ability, SLRT and motor and sensory system improvements. This method has allowed symptomatic relief from back pain for atleast 12 weeks.
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...
Disentangling the lumbar PIVD puzzle: A narrative review
Romanian Journal of Neurology
Lumbar prolapse intervertebral disc (PIVD) is a common back related disability throughout the world. It is one of common cause for work absenteeism and pose high economic burden on society. Till date, the etiology of lumbar PIVD has not been clearly established. Mechanical compression and chemical irritation are the major pathophysiological changes in lumbar PIVD. The accurate diagnosis of lumbar PIVD is a prerequisite for appropriate therapy. Lumbar PIVD results in significant disability and loss of productivity. Therefore, it is pertinent to summarize the intricacies and nuances of Lumbar PIVD as well as its evidence based management. Various cost effective and time saving protocols are available in surgical and non-surgical management of lumbar PIVD. In the present review, an attempt has been made to highlight etiology, underlying pathophysiological mechanisms of lumbar PIVD, as well as evidence based management of lumbar PIVD.
Discectomy for primary and recurrent prolapse of lumbar intervertebral discs
Journal of orthopaedic surgery (Hong Kong), 2012
To reviewed 416 patients who underwent discectomy for primary or recurrent prolapse of lumbar intervertebral discs (PLID). Records of 296 men and 102 women aged 19 to 60 (mean, 39) years who underwent discectomy for a primary PLID, and 14 men and 4 women aged 28 to 50 (mean, 40) years who underwent revision discectomy for a recurrent ipsilateral (n=14) or contralateral (n=4) PLID at L4-5 (n=14), L5-S1 (n=3), or L3-4 (n=1) were reviewed. The pain-free interval, side and degree of herniation, operating time, length of hospital stay, and pre- and post-operative visual analogue score (VAS) for pain were recorded. Clinical outcomes were evaluated using the modified Macnab criteria and the Oswestry Disability Index. Patients were followed up for one to 4 years. The mean operating time was significantly longer in revision discectomy (65 vs. 141 minutes, p<0.001, unpaired t-test). There was no significant difference between revision and primary discectomy in terms of length of hospital s...
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.
Clinical Evaluation of Caudal Epidural Steroid Injections in Managing Lumbar Disc Prolapse
Journal of Evolution of medical and Dental Sciences, 2015
Lumber disc prolapse as a cause of back and leg pain is quite a common presentation at a pain clinic which results in significant disability & overall loss of productive work. This study is an uncontrolled, prospective study that included 25 patients (15 males and 10 females) during the period 2013–2014 with signs and symptoms of back pain associated with lumber disc prolapsed with lumbar radiculopathy, in whom conservative treatment of least 6 weeks had failed. The present study was undertaken with the aim to observe the effectiveness of caudal epidural injection of a combination of depomedrol (Methyl prednisolone acetate) along with a local anesthetic (0.5% bupivacaine) in relieving symptoms of lumbar disc prolapse with radiculopathy. Quantitative assessment was done for back pain & leg pain separately using the visual analogue scale and the functional disability was measured using oswestry disability index (ODI) before the procedure and at regular intervals after the procedure fo...
Background: Prolapsed Lumbar Intervertebral Disc (PLID) is one of the most common health problems worldwide, as well as in our country, and is one of the potential causes of temporary disability, morbidity, and reasoning of absence at workplaces. Objective: To find out the outcome of C-arm guided transforaminal and caudal epidural steroid injection for low back pain with radiculopathy due to PLID. Methodology: This was a randomized clinical trial conducted among purposively selected 54 patients with PLID with radiculopathy as per selection criteria, attending the Department of Physical Medicine & Rehabilitation in BSMMU, Dhaka, from March 2020 to February 2021. Patients (N=54) were randomly allocated into two groups; patients in group A (n=26) were treated with C-arm guided transforaminal and caudal epidural steroid injection with conservative treatment, and patients in group B (n=28) were treated with conservative treatment only. All patients were followed up in 1 st week, 1 st month, and 3 rd month. Results: The mean age of the participants in group A and group B were 40.88 (± 8.70) and 43.00 (± 11.54) years, respectively. In group A, 9 (34.6%) were housewives, 4 (15.4%) were manual workers, while in group B, 10 (35.7%) were housewives, and 8 (28.6%) were manual workers. In group A, 21 (80.8%) had three disc involvement, while in group B, 19 (67.9%) had three discs involvement, where L4-5-disc involvement was most common in both groups. There was no significant statistical difference between the groups regarding VAS scores at baseline (p=0.235), 1st week (p=0.164), and 1st month (p=0.125). The VAS score was significantly reduced in group A compared to group B at 3 rd month (p=0.001). The ODI score was significantly reduced in group A compared to group B at 1st week (p=0.034), 1 st month (p=0.016), and at 3 rd month (p=0.001). Conclusion: C-arm guided transforaminal and caudal Epidural Steroid Injection significantly improves pain and functional outcomes of patients with radiculopathy due to PLID. Long-term, large scale and multicenter research studies are required to establish the outcome and effectiveness of this procedure.
2014
Background/Aims: Oswestry Disability index is an established tool for assessment of Spinal Disability. It has been translated into many languages and but observational study was translation, application and validation of Urdu version of the Oswestry Disability Index (Urdu ODI) for our specific cultural background. Methods: Urdu version of ODI was developed and applied for outcome assessment in 50 patients, suffering from lumbar prolapsed inter vertebral discs and treated with caudal epidural steroid injection. All patients having mechanical low backache with radiculopathy and single level disc prolapse at L-4-5 or L5-S1 on Magnetic Resonance Imaging (MRI) were included in the study. Single Steroid Injection with local anesthetic was injected into sacral caudal epidural space through sacral hiatus. A Performa was made for each patient and records were kept in a custom built Microsoft access database. Outcome was assessed using Urdu ODI and validation by comparing with Numeric rating...