Functional outcome after fenestration and discectomy in young adults presenting with unilateral radiculopathy

Abstract

Introduction: Lumbar disc herniation is one of the common ailments in young adults. The common levels of L4-L5 and L5-S1 have been chosen for ours. The Evaluation was done based on the level of disc herniation and also with different types of disc herniation such as contained, extruded, or sequestrated disc herniations. The outcomes were evaluated using the Japanese Orthopedic Association (JOA) scoring system. Methods: Thirty-three patients with a single-level disc herniation at L4-L5 or L5-S1 who did not show significant improvement of radiculopathy even after a conservative trial were included in the study. All patients were consented and subjected to surgery-unilateral fenestration and fragment discectomy. Patients were evaluated based on their JOA Scoring which was done preoperatively and postoperatively on day 10 and at 1 month, 3 months, 6 months, and 1 year. The functional outcome in percentage was calculated using the “recovery rate” by the Hirabayashi index. Results: Following fenestration discectomy, the functional outcome of the patient was found to be good. O the 33 patients operated, males n = 20 and females n = 13. According to Hirabayashi's recovery rate, 48% (n = 16) patients were found to have an excellent result with recovery rate of >80%. Good results were seen in 43% (n = 14) with recovery rates ranging between 70% and 80%. About 3% (n = 1) had a fair result with recovery rate of 56% and 6% (n = 2) had poor results with recovery rate < 50% following surgery. Applying the paired t-test, P was calculated and was 0.0001 which is statistically significant. Complications included incidental durotomy, pseudomeningocele, recurrent disc herniation, and spondylodiscitis. Conclusion: Patients who underwent fenestration discectomy for single-level lumbar disc herniation at L4/5 or L5/S1 showed significant functional improvement as per JOA scoring and Hirabyashi's recovery rate. The results were comparable with newer techniques such as micro and endoscopic discectomy.