Abstract
Background: Lumbar disc herniations are most common at L4/5 and L5/S1 levels and this is the most prevalent condition among manual laborers. The aim of the study was to analyze the clinical presentation, age and sex distribution, perioperative duration and immabulazation.
Methods: This is a retrospective study, which includes 250 patients operated for lumbar disc herniations at L4/5 and L5/S1 levels. A detailed history of presenting complaints, clinical examination and corresponding findings on imaging were correlated. In all these patients, there was severe symptomatology with failed conservative management, which necessitated classical open lumbar laminectomy and discectomy.
Results: The overall success rate was 96% in our series. Postoperatively, 9.2% of patients experienced localized low back pain, which was mild to moderate and being treated with NSAIDs and exercises.
Conclusions: In addition to removal of herniated disc, other compressing elements like hypertrophied Ligamentum flavum, facet arthropathy and narrowed spinal canal diameter were also addressed with an open procedure. To prevent later complications, these patients are supposed to avoid strenuous work, lifting weights, torsion and jerky movements, faulty posture at work and rest, gait training, crouching, sitting on the floor and haunches.
References
- Marketos, S.G. and P. Skiadas, Hippocrates. The father of spine surgery. Spine (Phila Pa 1976), 1999. 24(13): p. 1381-7.
- Marketos, S.G. and P.K. Skiadas, Galen: a pioneer of spine research. Spine (Phila Pa 1976), 1999. 24(22): p. 2358-62.
- Truumees, E., A history of lumbar disc herniation from Hippocrates to the 1990s. Clin Orthop Relat Res, 2015. 473(6): p. 1885-95.
- Schoenfeld, A.J., Historical contributions from the Harvard system to adult spine surgery. Spine (Phila Pa 1976), 2011. 36(22): p. E1477-84.
- Mixter WJ, B.J., Rupture of the intervertebral disc with involvement of the spinal canal. N England J Med, 1934. 211: p. 210-15.
- Weinstein, J.S. and K.J. Burchiel, Dandy'S disc. Neurosurgery, 2009. 65(1): p. 201-5; discussion 205.
- Dandy, W.E., Loose cartilage from intervertebral disk simulating tumor of the spinal cord. By Walter E. Dandy, 1929. Clinical orthopaedics and related research, 1989(238): p. 4-8.
- CM, S., Medicinen och det mänskliga2003: Natur och Kultur.
- Raj, P.P., Intervertebral disc: anatomy-physiology-pathophysiology-treatment. Pain Pract, 2008. 8(1): p. 18-44.
- Roberts, S., et al., Histology and pathology of the human intervertebral disc. J Bone Joint Surg Am, 2006. 88 Suppl 2: p. 10-4.
- Latimer, B., The perils of being bipedal. Ann Biomed Eng, 2005. 33(1): p. 3-6.
- Plomp, K.A., et al., The ancestral shape hypothesis: an evolutionary explanation for the occurrence of intervertebral disc herniation in humans. BMC Evol Biol, 2015. 15: p. 68.
- Harrington, J., Jr., et al., The relation between vertebral endplate shape and lumbar disc herniations. Spine (Phila Pa 1976), 2001. 26(19): p. 2133-8.
- Plomp, K.A., C.A. Roberts, and U.S. Vietharsdottir, Vertebral morphology influences the development of Schmorl's nodes in the lower thoracic vertebrae. Am J Phys Anthropol, 2012. 149(4): p. 572-82.
- Adams, M.A. and P. Dolan, Intervertebral disc degeneration: evidence for two distinct phenotypes. J Anat, 2012. 221(6): p. 497-506.
- Uesugi, K., et al., Relationship between lumbar spinal stenosis and lifestyle-related disorders: a cross-sectional multicenter observational study. Spine (Phila Pa 1976), 2013. 38(9): p. E540-5.
- Jansson, K.A., et al., Health-related quality of life in patients before and after surgery for a herniated lumbar disc. J Bone Joint Surg Br, 2005. 87(7): p. 959-64.
Corresponding Author
Dr Seraj Al-Zentani
Faculty of Medicine, University of Benghazi
DOI: https://dx.doi.org/10.18535/jmscr/v12i10.03
