Title: A Prospective Clinical Study of Surgical Management of Lumbar Intervertebral Disc Prolapse in Adults by Laminectomy and Discectomy

Authors: Shaheed Abdul Arshad, Dr Viswanath Naik, Dr S Lakshmi Narayana

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i12.145

Abstract

Back pain, is now appearing as a modern international epidemic. Upto 80% of people are affected by this symptom at some time in their lives. Intervertebral disc disease and disc herniation are most prominent in otherwise healthy people in the 3rd and 4th decades of life. It accounts for a majority of cases of low backache seen by an orthopaedician in clinical practice and is a major contributor of functional disability.In 1934, Mixter and Barr published their study that concluded that laminectomy with decompression and extraction of herniated lumbar disc could, improve suffering caused by sciatic pain. Open discectomy is one of the standard procedure for operative intervention in patients with herniated limber discs whose conservative treatment has failed. However, the outcome studies of lumbar disc surgery document a success rate of 51 to 89%, in spite of advances in investigations, operative technique and postoperative care. Therefore the need for appropriately presenting and reviewing this subject is important.

Aims and Objectives

  • To study the outcome of the surgical management of lumbar intervertebral disc prolapse in adults by laminectomy and discectomy
  • To know the complications following laminectomy and discectomy for lumbar intervertebral disc prolapse

Methods: 30 Cases of lumbar disc prolapse treated with laminectomy and discectomy satisfying inclusion and exclusion criteria treated in MGM Hospital fromjuly 2015 to oct 2017 were studied.

Results: The present study comprised of 30 Cases of lumbar disc prolapse treated with laminectomy and discectomy. The follow up of upto 2 years. Male patients (60%) outnumbered female patients (40%) in incidence. More common in 40 to 60 years age group with the average of 44.9 years (18 to 64 years). Radicular pain was the most common symptom. Positive SLRT was the most common sign.76.67% of cases had a pre-op JOA score between 6 and 10.L4 -L5 was the most common disc to herniated. Average duration of hospital stay was 10.3 days ranging from 6 days to 24 days.93.3 % of cases had a post-op JOA score between 11 and 15.86.6% cases had a good outcome. Complications were superficial infection in 2 cases (6.6%), dural rupture in 2 cases(3.3%).

In our study we achieved 86% excellent to good results, 10% of fair results with a complication rate of 3.3% only. The results were comparable to other studies.

Keywords: laminectomy, Discectomy, Lumbar Disc prolapsed.

References

  1. Junge A, J.Dvorak, and S.Ahrens, 1995: “Predictors of lumbar disc surgery outcomes”. Spine, 20(4): 460-468.
  2. Pappas T.E., T.Harrington and V.K.H. Sonntag, 1992: “Outcome analysis in 54 surgically treated lumbar disc herniations”. Neurosurgery, 30(6): 862-866.
  3. Davis R.A., 1994: “A long-term outcome analysis of 984 surgically treated herniated lumbar discs”. J.Neurosurg, 80: 415-421.
  4. Bradford FK, Springfield RG, The. Intervertebral Disc 2ndEdition1945
  5. Abramovitz Jn, Neff SR. Lumbar disc surgery: Results of the prospective discectomy study of the joint section on disorders of the spine and peripheral nerves of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons. Neurosurgery. 1991;29:301-7.
  6. Hirabyashi S, Kumano K, Ogawa Y, et al. Microdiscectomy and second operation for lumbar disc herniation. Spine.1993; 18:2206-11.
  7. PopleI K, Griffith HB. Prediction of an extruded fragment in lumbar disc patients from clinical presentation. Spine. 1994;19:156-9.
  8. Junge A, Frohlich M, Ahren S, etal. Prediction of bad and good outcome of lumbar spine surgery-A prospective clinical study with 2years follow up. Spine.1996;21:1056-65.
  9. McCulloch JA.Focus issue on lumbar disc herniation: Macro and microdiscectomy. Spine.1996;21:453-568.
  10. Carregee EJ,Kim DH.A prospective analysis of MRI findings in patients with sciatica and lumbar disc herniation: correlation of outcomes with disc fragement.Spine.1997;22:1650-60.
  11. Loupasis,George A, etal.Seven to twenty year outcome of lumbar discectomy. Spine. 1999;24(22):2313.
  12. Porchet F,Vader JP, et al.The assessment of appropriate indications for laminectomy. JBJS-British volume.1999; 81-B(2):234-9.
  13. Arthand Per, Maattanen Hannu.Pain and orthopaedic and neurologic signs after lumbar discectomy: A 2 year followup. CORR.2000:154-60.
  14. Benz, Robert J.Current techniques of decompression of lumbar spine. Clinical orthopaedics and related research. 2001;1(384):75-81
  15. Morgan Hough CVJ, PW Jones, SME isenstein. Primary and revision lumbar discectomy: A 16 year review from one centre. J Bone Joint Surg Br.2002;85 (6):871-4.
  16. Yadav RK. Evaluation of myelography and computed tomography in clinically diagnosed patients and lumbar disc herniation. JInd Med Assoc.2003;101 (1):578-84
  17. Hakkinen A,Ylinen J,Kautiaine H, Airaksinen O, Herno A, KivirantaI. Dose the outcome 2 months after lumbar disc surgery predict the outcome 12 months later?.Disabil Rehabil.2003;25(17):968-72.
  18. Schinichi H, Masatoshi N, Masahiro K. Intraoperative measurements of nerve root blood flow during discectomy for lumbar disc herniation.Spine.2003;28(1):85-90.
  19. Toyone T, Tanaka T, Kato D, Kaneyama R. Low back pain following surgery for lumbar disc herniation: A prospective study. J Bone Joint Surg Am.2004;86 (5):893-6.
  20. Guido Saxler, Jurgen Kramer, Bertram Barden, Asik Kurt, Jorg Pfortner, Kai Bernsmann. The long term clinical sequelae of incidental durotomy in lumbar disc surgery.Spine.2005;30(20):2298-2302
  21. Tomoaki Toyone, Tadashi Tanaka, Diasuke Kato, Ryutaku Kaneyama, Mokoto Patients’ expectations and satisfaction in lumbar spine surgery. Spine.2005; 30(23):2689-2694.
  22. Mariconda et al. Minimum 25 year outcome and functional assessment of lumbar discectomy.Spine.2006;31:2593-2599.
  23. Milano C et al. The functional relevance of neurological recovery after lumbar discectomy: A follow up of more than 20 years. J Bone and Joint Surg British. 2008;90(5):622-8.
  24. Amiy Jhak, Manish Mistry. Endoscopic lumbar discectomy: Experience of first 100 cases.IJO.2010;44(2):184-90.
  25. Saumyajit Basu, Jay Deep Ghosh, Farid H Malik, Agnivesh Tikoo. Postoperative discitis following single level lumbar discectomy: our experience of 17 cases. IJO.2012;44(4):427-433.
  26. Brian P Walcott, Jean-Valery Coumans. Post laminectomy synovial cyst formation: A possible consequence of ligamentum flavum excision. Journal of Clinical Neuroscience. 2012;19:252-4.
  27. Chia-Liang Ang, Benjamin Phak-Boom Tow, Stephanie Fook, Chang-Ming Guo, John Li-Tat Chen, Wai-MunYue, Seang-Beng Tan, etal. Minimally invasive compared with open lumbar laminectomy: no functional benefit at 6 or 24 months after surgery. The spine Journal. 2013.07.461.
  28. Ashuthosh B Sabnis, Ashish D Diwan. The timing of surgery in lumbar disc prolapse: A systemic review. IJO.2014;48 (2):127-35.

Corresponding Author

Shaheed Abdul Arshad

Email: This email address is being protected from spambots. You need JavaScript enabled to view it., 9985555393