Prospective Study of Open Lumbar Discectomy in Different Stages of Disc Prolapse

Abstract

Introduction Lumbar disc herniation has been recognized as an important cause of low back pain. Intervertebral disc prolapse occurs predominately in L4–L5 and L5–S1 level. It includes three stages mainly protrusion, extrusion, and sequestration. Results of operative treatment for disc lesion vary depending on the level of lesion and duration of symptoms, this study aims to assess the outcome of discectomy in the different stages of disc lesion. Patients and Methods A prospective study was done in 40 patients diagnosed with lumbar intervertebral disc prolapse. Demographic data, history, clinical examination, and details of investigations and intervention in the form of open lumbar discectomy/fenestration were recorded in the study proforma. Clinical follow-up was done at 2 weeks, 3 months, 6 months, and 1 year intervals regarding pain, disability, and the functional outcome were evaluated with VAS, Modified ODI score, and SF-36 questionnaire. Results In our series of 40 patients, 8 (20%) were in 21 to 30 years, 18 (45%) in 31 to 40 years, 5 (12.5%) in 41 to 50 years, 8 (20%) in 51 to 60 years, 1 (2.5%) in 61 to 70 years age groups. Overall, 47.5% of patients had disc protrusion, 40% had extrusion, and 12.5% had sequestration. Overall, 60% were males and 40% were females. Overall, 75% of patients had L4–L5 disc lesion, 12.5% had L5–S1 lesion, 10% had both L4–L5, L5–S1 lesion, and 2.5% had L3–L4 lesion. Fenestration was done in 82.5% patients and laminectomy done in 17.5%. Postoperatively, neurological deficits and SLRT improved. There were statistically significant reduction of pain, improvement in disability, and a better functional outcome at the end of 1 year as assessed by VAS, modified ODI score, and SF-36 questionnaire in all the three stages of disc lesion; however, the improvement was better in stage 1 and stage 2 compared with stage 3. Complications included superficial wound infection, neurological deficit, and failed back syndrome. Conclusion Open lumbar discectomy by fenestration/laminectomy is a safe, effective and reliable surgical procedure in all stages of intervertebral disc prolapse, the outcome is better in stage 1 and stage 2 lesions than in stage 3 lesions.