Outcome of Surgical Management in Lumber Disc Prolapse: A Study in Dhaka Medical College Hospital, Dhaka, Bangladesh

Abstract

A disc herniation is the term given to any uneven out-pouching or bulging of the posterior region (back region) of the intervertebral disc as seen on MRI. The bigger the lumbar/sacral disc herniation, the more likely it is to cause back and/or leg pain--the latter of which is called sciatica1. The aim of this study was to evaluate the surgical outcome in the treatment of Lumber Disc Prolapse (LDP). The prospective interventional study (Quasi experimental) was done in the Department of Orthopedics and Traumatology, Dhaka Medical College and Hospital during the period of June 2009 to July 2011(2 years). Due to time limitation and financial constraint only 35 cases were selected during study period but out of them 29 cases were feasible to be included in the study, remaining 6 cases were lost during follow up. Patients of both sexes aged between 18-70 years with prolapsed lumber intervertebral disc admitted in the Department of Orthopedics and Traumatology were included as purposive sampling. Data was entered, coded, cleaned, and analyzed by using Statistical Package for Social Science (IBM SPSS), version 20. In our study we found, Clinically 17(58.6%) of patients had weakness in extensor hallucis longus (EHL) and 3(10.3%) of patients had weakness in flexor hallucis longus (FHL). 14(48.3%) of patients had sensory deficit over the distribution of L5 nerve root and 6(20.7%) had S1 nerve root. In X-ray there were 6 transitional vertebra and loss of lumbar lordosis was in 20 patients. MRI shows 20(62.5%) of patients had posterolateral disc bulge and 12(37.5) had posterior disc bulge. In majority of patients (65.5%) of patients had disc prolapse at level L4-L5. 53.7% of patients had left sided disc prolapse. Peroperatively seen that 62.5% of the patients had posterolateral disc prolapse and 37.5% patients had central disc prolapse. There were only 10.3% of patients had complications. Among these 6.9% had per operative dural tear and 3.4% developed discitis. At the final follow up most of the patients were pain free. All patients had absence of muscle spasm. No patients had restriction of mobility. Most of the patients regaining their straight leg raising in between 60-90 degree. The overall result of surgery was encouraging. Relief of symptoms occurred in 28 (96.6%) of patients. Out of 35 patients 40% of patients returned to work within 3 weeks of operation and 46.6% patients returned to work within 6 weeks of operation but rest of the cases still did not return to their previous work due to pain.