Prolapsed Lumbar Intervertebral Disc Research Articles

Prolapsed Lumbar Intervertebral Disc (PLID) Surgery and Our Experiences

Background: Herniated lumbar disc is the most common specific cause of low back pain. Surgery results in better outcome for cases with exclusive severe radicular pain and health-related quality of life improves after lumbar disc herniation (LDH) surgery. Objective: To determine the outcome of lumbar disc herniation surgery and to assess the effect of factors that could predict the outcome of surgery. Materials and method: This observational study was done in Delta Medical College & Hospital, Mirpur, Dhaka, during March 2016 to January 2019. We evaluated 54 patients who had undergone operations for lumbar disc herniation using three different surgical techniques (laminectomy, fenestration and discectomy, and spinous process osteotomy) for low back pain and radicular pain. Results: Forty six (85.19%) patients were male and 8(14.81%) were female. Age range was 18-60 years. Forty nine (90.74%) were new patient and 5(9.26%) had recurrent disc prolapse. Diagnosis was confirmed by MRI. Fifty (92.59%) patients had no pain after surgery and only 2(3.70%) patients needed reoperation and 2(3.70%) had occasional pain. Conclusion: Surgery for lumbar disc herniation is effective in reducing radicular pain. All three surgical approaches resulted in significant decrease in preoperative radicular pain and low back pain, but 100% good outcome was not achieved. Delta Med Col J. Jan 2021;9(1): 28-32

Comparison Between Clinical Findings and Magnetic Resonance Imaging Findings in Lumbar Prolapsed Intervertebral Disc

Introduction: Lumbar prolapsed intervertebral disc is commonly associated abnormality with lower backache. Disc herniation of same size can be asymptomatic in one patient and agonizing in another patient. Magnetic resonance imaging (MRI) is a gold standard diagnostic investigation for prolapsed intervertebral disc. Despite of high sensitivity sometimes MRI shows abnormal findings even in the asymptomatic individuals indicating a moderate relationship between MRI and symptoms in the patient. The study was conducted to correlate the abnormalities observed on MRI and clinical features of lumbar disc prolapse. Methodology: A descriptive cross-sectional study was conducted from 20 December 2021 to 15 September 2022. Ethical approval was obtained from the Institutional Review Committee (Reference number: 078/78-009/HG). A convenience sampling method was used. The study consisted of patients with low back pain and radiation to lower extremity or patient with MRI scan of lumbar spine. Clinical and MRI findings were correlated to know the association and significance of MR findings in producing symptoms. Results: The study included 68 patients with back pain between 18 to 55 years (mean 41± 8.79 years). Neurological symptoms were present in 26 (38.23%) patients. Disc bulge in MRI was noticed in 48 (45.28%), protrusion in 46 (43.39%) and extrusion in 10 (11.32%) levels, most seen at L5-S1 level (66.11%). The clinical level of pain distribution correlated well with the MRI level (Kappa 0.69), but not all disc bulges produced symptoms. Conclusion: Clinical features and Magnetic resonance imaging findings of disc prolapse had significant correlation similar to other studies done in a similar setting, but all imaging abnormalities may not have a clinical significance. Keywords: magnetic resonance imaging; intervertebral disc; prolapse; radiculopathy; correlation of data.

Effect of Agnikarma with Kshoudra over Ankle and Foot in Sciatica due to L4-L5 Intervertebral Disc Prolapse

Sciatica is a syndrome characterized by pain radiating from the low back into the buttock and into the lower extremities along its posterior or lateral aspect and most commonly caused by prolapse of lumbar intervertebral disc. The term is also used to refer the pain anywhere along the course of sciatic nerve. Modern medical practice for sciatica includes oral NSAIDs, opioid and non-opioid analgesics, muscle relaxants, localized corticosteroid injections, physiotherapy and if the above measures fail finally surgery. Sciatica can be correlated with Gridhrasi mentioned under Vata vyadhi in Ayurvedic classics. Various treatment modalities like Snehana, Swedana, Vasthi etc are indicated in Gridharsi. These are very effective treatment procedures but take relatively a more time for pain relief. Agnikarma is very beneficial in painful conditions caused by Vata as it gives immediate relief of pain. Here the patient was treated with Agnikarma using Kshoudra over the tender spots of ankle and foot of affected lower limb. Outcome measures like pain, numbness, tenderness, SLR and ODI were assessed before treatment, after treatment, 7th day and on 14th day. The result showed that Agnikarma with Kshoudra done over ankle and foot gives immediate relief of pain and numbness of sciatica due to L4-L5 intervertebral disc prolapse.

C-Arm Guided Epidural Steroid Injection: An Effective Treatment for Patients with Radiculopathy in Tertiary Level Hospital of Bangladesh

Introduction: Epidural steroid injections (ESI) have been utilized for over 50 years in the conservative therapy of prolapsed lumbar intervertebral discs. However, controversy persists regarding their effectiveness in reducing pain and improving function, with literature supporting and opposing them.
 Aim: To study the effectiveness of epidural steroid injection in treating pain caused by a prolapsed lumbar intervertebral disc and compare the effectiveness between caudal, transforaminal, and interlaminar injection routes.
 Materials and Methods: A total of 152 patients with back pain with Radiculopathy with a lumbar disc prolapse confirmed on MRI were included in the study. Their pre-injection Japanese Orthopedic Association Score (JOA) counted up. In this study, participants were enrolled using a simple randomization procedure (picking a card).in the Department of Physical Medicine & Rehabilitation at BSMMU, Dhaka, from May 2020 to April 2021. Among 152 patients were intervenes as transforaminal (n=62), caudal (n=53), and interlaminar (n=25) approach with subsequently received epidural steroids as methylprednisone. Twelve individuals were dropped from the trial because they failed to show up for their scheduled therapy.
 Results: The prevalence increased dramatically, leading to a JOA Score at 12 months following injection via any of the three methods 53 (37.26%) via the caudal pathway, 62 (44.21%) via transforaminal, and 25 (18.53%) via interlaminar. At six months and 12 months post-injection, the transforaminal route was substantially more efficacious than the caudal (p=0.01) and interlaminar routes (p=0.03). Comparing the caudal and interlaminar methods yielded no statistically significant difference (p=0.36).
 Conclusion: In the current study, methylprednisone epidural injections effectively treat radiculopathy and back pain caused by a herniated lumbar disc. All three injection techniques are adequate, with the best result obtained by the transforaminal route.
 TAJ 2022; 36: No-1: 113-118

A Comparative Study of McKenzie Back Program and Conventional Physiotherapy in Relieving Backache due to Lumbar Disc Prolapse

Introduction: Low Back Pain (LBP) is considered as one of the commonest problems, in which pain felt in the lumbosacral spinal and paraspinal regions which encompass the buttocks and upper thigh. Objectives: The main objective of the study is to find the comparison between McKenzie back program and conventional physiotherapy in relieving backache due to lumbar disc prolapse. Material and methods: This cross sectional study was conducted in Rashid Latif Medical College Lahore during January 2022 to June 2022. Persons having MRI and previously diagnosed as Disc herniation or Lumbar disc herniation LDH or Prolapsed Lumbar intervertebral disc (PLID) were also enrolled and screened for the second time, the persons who had no MRI were advised to perform with proper justification. Results: Data was collected from 40 patients. There were 22 females and 18 males. Both groups were matched as regards age, gender, weight, height, and BMI. ODI scores showed a significant decrease in both groups post-treatment (p = 0.001) indicating a decrease of functional disability. The percentage of decrease in Oswestry scores was higher in group B than group A (6.87% versus 4.82%). Practical Implication: This study will be helpful in reducing pain, increasing lumbar spine mobility and decreasing disability. Conclusion: It is concluded that McKenzie back program is more effective in reducing pain, increasing lumbar spine mobility and decreasing disability than conventional physiotherapy and stretching exercises in patients with backache due to lumbar disc prolapse. Keywords: Effective, Backache, Pain, Disability

Research on the Medical Knowledge Deduction Based on the Semantic Relevance of Electronic Medical Record

This paper studies the extraction of information from unstructured text data of medical literature and electronic medical records in the field of medicine, and proposes a TCM-KR method of knowledge reasoning based on electronic medical records to enhance association rules, and carries out a study on association characteristics in the field of the electronic medical record. This method abstracts the word bag representation mode of text semantics from the unstructured data representation and integrates the correlation information of the knowledge graph of the medicine domain. The method based on a graph convolutional network was used to predict the unknown associations' relations between viscera, channel tropism, and channel distribution. The experimental results show that the TCM-KR method can efficiently infer a large amount of high-quality triple knowledge from the unstructured text data of medicine, and predict the correlation characteristics of Syndromes-Viscera, Chinese medicinal-Channel tropism, Acupoints-Channel distribution in treating lumbar intervertebral disc prolapse and provide a dedicated machine learning model and guidance for clinical diagnosis and treatment.

Early outcome of radiculopathy with local application of steroid in perineural space in lumbar discectomy

Lumbar disc herniation resulting in compression and inflammation of nerve roots causes low back pain and radiculopathy. Per-operative use of steroids may help reduce inflammatory reaction and scar formation, causing less postoperative pain. The study aimed to assess the early outcome of radiculopathy with local application of steroids in peri-neural space after lumbar discectomy. This experimental study was carried out in the Department of Neurosurgery of the National Institute of Neuroscience and Hospital (NINS&H), Dhaka from March 2019 to August 2020. A total of 68 patients operated for prolapsed lumbar intervertebral disc (PLID) at L4/L5 and /or L5/S1 levels were divided into two groups. Patients who did not receive steroids (n=34) and those who received steroids (n=34) in peri-neural space were considered group A and group B, respectively. Patients were examined on the 1st, 2nd and 14th postoperative days to measure the pain intensity by the Visual Analogue Scale (VAS). Pre-operatively mean (standard deviation, sd) VAS was 7.41 (1.28) in Group A and 7.91 (0.9) in Group B (p-value >.05). Mean (sd) improvement of pain intensity on day 1, was 58.82 (17.55)% in Group A and 70.59 (12.26)% in Group B from pre-operative VAS. On day 2, 71.69 (12.43)% improvement was seen in Group A and 79.78 (9.74)% in Group B. On day 14, 75.37 (9.96)% improvement was seen in Group A and 83.46 (7.36)% in Group B from pre-operative. The improvements of VAS in all 1st, 2nd and 14th days were statistically significant (p-value <.05) between the two groups. Local application of steroids in peri-neural space found effective in reducing early postoperative radiculopathy following lumbar discectomy. BSMMU J 2022; 15(2): 107-109

Outcome of C-arm Guided Epidural Steroid Injections in Patients with Prolapsed Lumbar Intervertebral Disc with Radiculopathy

Background: Prolapsed Lumbar Intervertebral Disc (PLID) is one of the most common health problems worldwide, as well as in our country, and is one of the potential causes of temporary disability, morbidity, and reasoning of absence at workplaces.

Physiotherapy interventions versus surgical interventions for patients with prolapsed lumbar intervertebral disc (PLID): A critical review

Physiotherapy interventions versus surgical interventions for patients with prolapsed lumbar intervertebral disc (PLID): A critical review

Conservative Treatment Alone and with Diclofenac Sodium Phonophoresis on The Patients With Low Back Pain Due to Prolapsed Lumbar Intervertebral Disc

Background: Prolapsed lumbar intervertebral disc (PLID) one of the major causes of low back pain. The PLID has become an important and increasingly general health problem, both in Bangladesh and across the world. Phonophoresis has been used clinically since the early 1960s in attempts to drive these drugs transdermally into subcutaneous tissues. The efficacy of Phonophoresis has not been conclusively established in PLID linked low back pain. Objective: To evaluate the effects of Diclofenac Sodium Phonophoresis on patients with low back pain due to PLID. Materials and Methods: The comparative study was conducted on the 72 patients diagnosed as PLID after being confirmed by Magnetic Resonance Imaging (MRI) and, were randomly assigned to Group A(Control group) and Group B (Case group), 36 patients in each group. Visual analog scale (VAS), Straight leg raising (SLR) test used to assess the effects on the last 3rd day of the consecutive week. Results: There were significant differences of improvement in outcome measure between the two groups from pretreatment to week 4. After 4 weeks of treatment VAS score in Group A was 2.10±0.5 and in Group B was 1.7 ± 0.5,P-Valuewas0.026.The significant improvement was observed in Group B patients, and according to Straight leg raising test of patients in Group A was 65.27± 7.36 and for group B it was 75.1 ±6.9. P-Value of 0.069 implies that it was not significant. Conclusion: Effectively managed Diclofenac sodium Phonophoresis can reduce the pain consistency of PLID to a major extent. KYAMC Journal Vol. 13, No. 03, October 2022: 158-164

Prolapsed Lumbar Intervertebral Disease through Acupuncture Treatment in Bangladesh: A Case Study

Two of the most frequent health conditions are low back pain and sciatica. Both the number of hours worked and the amount of money lost by workers and the country as a whole are drastically reduced. It's important to undertake a comprehensive physical evaluation on these people before initiating any therapy. It is likely that symptoms can increase as a consequence of obtaining inadequate medicinal or surgical care. To observe acupuncture's influence on prolapsed lumbar intervertebral disc therapy. This inquiry took place at Suo-Xi Hospital at Shantinagar, Dhaka, Bangladesh. A 40-year-old male patient has been complaining of lower back discomfort for the last two months. The diagnosis was confirmed with a cervical spine Magnetic resonance imaging. Follow-up research showed promising outcomes. He no longer felt discomfort in his lower back, which he had been experiencing for two months. Prolapsed lumbar intervertebral disc patients may benefit from acupuncture, according to the findings of this study.

A prospective study in management of lumbar radiculopathy patients with selective nerve root block

Background: Prolapsed Intervertebral Disc (PID) was considered to be the commonestcause of sciatica among many others. Though the presentation of sciatica wasparadoxical, in which, some people experienced sciatica without any disc prolapse onMRI/CT, whereas some people showed a prolapsed disc without experiencing any ofthe symptoms related to sciatica. This gave rise to different explanations that a discprolapse in itself , is not enough to cause sciatica, and there might be some localchemical agents that might be the causative factor due to their insulting attitude on thenerve roots.Objectives:To study the functional outcome of patients with Posterior LumbarIntervertebral disc prolapse (PLIVDP), Lumbar Canal Stenosis, andLumbar radiculopathy after Selective Nerve Root Block at thecorresponding level.Materials and Methods:A prospective cohort study on the functional outcome of patients with lumbarradiculopathy with Intervertebral disc prolapse or lumbar canal stenosis. Outcomemeasures used in this study are Owestry disability index score and Numerical ratingscale. All patients had taken an MRI scan, which was classified according to theMichigan state university classification. After initial check up, pre-anaestheticcheckup, selected patients were given Selective Nerve Root Block with MethylPrednisolone and local anaesthetic Bupivacaine. Patients were scored at Immediatepost Op, 3 weeks and 3 months after the injection was given and the data wascollected.Results:A total of 127 patients were given Selective Nerve Root Block in the studyperiod. Patients that were aged from 20-80 years were included. Average pre-injection ODI scores (in percent) were 75.24, at 1 month 20.52and at 4 months 19.86, with a p value of <0.001. Mean NRS ratings pre injectionwere 8.73, Immediate post op were 1.89, at 4 weeks it was 1.48 and 4 months 1.27. MeanSLR (in degrees) Pre Injection was 48.3, Immediate was 80.00, at 4 weeks was 80.2 and at 4 months was 80.5.Conclusion:Selective Nerve Root Block is a good therapeutic procedure for pain management in the patients with Lumbar radiculopathy, and it can be used as a standard procedure, before advising the patient for any form of surgery Keywords: SNRB, Lumbar canal stenosis, Sciatica, Radiculopathy

The Surgical Outcome for Prolapsed Lumbar Intervertebral Disc Based on Visual Analog Scores

Objective: To determine the surgical Outcome for a prolapsed lumbar intervertebral disc based on a visual analog score.
 Materials and Methods: A prospective study was conducted in the Department of Neurosurgery at Jinnah Postgraduate Medical Centre, Karachi. A total of 55 patients were included in the study. Questionnaires were used to collect demographic data, presenting symptoms, and the level of the herniated discs. The patients underwent different surgical interventions and then these patients were followed for 2 weeks postoperatively and the surgical outcome was assessed using the Visual Analog Score (VAS).
 Results: A total of 34 (61.8%) males and 21 (38.2%) females were included in this study. The average age of the patients was 36.14 ± 9.30 years. L5/S1 was the most commonly affected level. Laminar fenestration was the most common surgical procedure done in 23 (41.8%) patients followed by hemilaminectomy in 19 (34.5%) patients and bilateral laminectomy in 13 (23.6%). Post-operative pain was relieved in the majority of patients which is 43 (78.2%).
 Conclusion: Medical management remains the mainstay in the majority of patients having lumbar disc prolapse. However, in cases where the pain is refractory to conservative management, surgery is considered after careful patient selection. It was seen that surgical intervention successfully reduced the intensity of pain and resulted in a symptomatically improved patient. Hence it is safe to conclude that surgery is an effective measure and ultimately enhances the quality of life.

Effectiveness and Functional Outcome of Fenestration and Discectomy by Mini-Incision for the Prolapsed Lumbar Intervertebral Disc

Background: Lumbar intervertebral disc herniation is a common health problem in our country. Majority of the surgeries of the spine are done due to disc herniation in Bangladesh. Discectomy can be limited to partial discectomy where only extruded and sequestrated portion is removed, subtotal discectomy where the whole of nucleus pulpous is removed and total discectomy where the entire intervertebral disc of the affected level is removed. Aim of the study: To find out the effectiveness and functional outcome of fenestration and discectomy by mini-incision for the prolapsed lumbar intervertebral disc in our context. Material & Methods: This prospective observational study was conducted at National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh during July 2015 to June 2017. A total of 31 patients with prolapsed lumbar intervertebral disc were included for the study according to inclusion and exclusion criteria. Results: The mean age was 35.98 ± 8.50 years with the range from 17 to 50 years. In this study, the most common muscle weakness in EHL. Out of 31 patients, 22 (70.96 %) patients were in this group. 08 (25.80%) cases had weakness in FHL and another group 01 (3.22%) had both muscle weakness. Out of 31 patients, 30 (96.78%) patients had preoperative sensory deficit and 03 (09.67%) patients had postoperative sensory deficit, which is statistically significant. In preoperative period, moderate pain in 27 (83.87%) patients, severe pain in 04 (12.90%) patients. In postoperative period had no pain in 22 (70.96%) patients, mild pain was noted in 08 (25.08%) patients, moderate pain in 01 (03.22%) patient. 20 (64.51%) patients had para spinal muscle spasm in the preoperative period, whereas no patient had any spasm in 3 months postoperatively. The success rate was 100% and the result was statistically significant. In this present series, functional outcome was assessed according to Macnab criteria. 08 (25.80%) cases were excellent, ...

The Prevalence of Low Vitamin D3 Levels in Patients with Lumbar Disc Herniation and Its Relationship with Different Patient Parameters

Objective: To determine the prevalence of low vitamin D3 levels in patients having proven lumbar disc herniation and its relationship with different patient parameters. Materials and Methods: This is a prospective study carried out on 100 patients at the Neurosurgery department, Jinnah postgraduate medical center from Feb 2018 to April 2019. Serum Vitamin D levels and other characteristics were assessed in patients with prolapsed lumbar intervertebral discs. Low levels of Vitamin D were defined as insufficiency (10 ng/ml – 30 ng/ml) and deficiency (< 10 ng/ml). Results: Out of 100 patients in the study, only 21% had optimal serum vitamin D3 levels, and 79% had hypovitaminosis (57% insufficient and 22% deficiency). Low vitamin D levels were prevalent in all age groups, with deficiency more prevalent in the older age group (p-value = 0.004). The BMI (body mass index) of the patients showed a linear correlation with vitamin D levels. Conclusion: Decreased vitamin D levels are prevalent in patients having herniated lumbar discs. The study showed that older-aged patients and high BMI exhibited severe vitamin D deficiency. As a result, recommendations are that preventive initiative for this specific hypovitaminosis target a broader population to intercept the occurrence of low vitamin D levels and the associated repercussions.

Outcomes of minimally invasive spine decompression in lumbar spinal stenosis and intervertebral disc prolapse: A prospective study

Introduction: Lumbar spinal stenosis and intervertebral disc prolapse are the most common cause of back pain and sciatica. Both conditions are traditionally treated by a midline lumbar incision, after which the paraspinous muscles are elevated from the spinous processes and lamina and retracted laterally and extensively. Minimally invasive lumbar decompression is a procedure designed to debulk hypertrophied ligamentum flavum and removal of the herniated disc with a goal of relieving neural compression. Our study aimed to assess the outcome in terms of improvement in neurology, extent of pain relief in the postoperative period and complications in patients undergoing minimally invasive spine decompression.Methodology: The present study was conducted in a tertiary care hospital. A total of 16 patients who satisfied both the inclusion and exclusion criteria and gave informed consent were recruited for the study from January 2020 to March 2021. All patients underwent minimally invasive spine decompression by tubular retractors. Outcome measures used are Visual analog score for leg pain and back pain, Modified Oswestry Disability Index (MODI), Roland Morris Disability Questionnaire (RMDQ) and neurological examination preoperatively and postoperatively at 6 weeks, 3 months and 6 months.Results: Out of 16 patients, ten patients had intervertebral disc prolapse and six had lumbar spinal stenosis. L4L5 was the most common level seen in our patients. Mean pre-operative VAS score was 6.88 and 4.44 for leg pain and back pain, there was significant reduction at the end of 6 months. Mean preoperative MODI score was 66.38, preoperatively 13 patients (81%) had crippling back pain, 3 patients (18.75%) had severe disability. At the end of 6 months, all 16 patients had less than minimal disability. Mean preoperative roland morris disability score was 11.31+ 0.61. There was a significant mean improvement at 6 months postoperatively from the preoperative baseline score. Nine patients (43.8%) had a motor deficit of which 4 patients had a significant motor power improvement. Two patient had complications, one patient had CSF leak intraoperatively and the other patient developed a superficial wound infection.Conclusion: Minimally invasive spine surgery is an excellent surgical option in patients with lumbar spinal stenosis and prolapsed intervertebral disc. Patients who underwent minimally invasive spine decompression had satisfactory functional outcome in terms of pain relief, minimal hospital stay and early return to day to day activities.

Tuberculosis of Spine: A rare presentation case report and treatment protocol

Spinal tuberculosis (ST), or Pott’s disease, was first described by Sir Percival Potts in 1779, albeit lacking a deep understanding of its etiology or pathophysiology. It was only after several years that the basis of ST was discovered to be the bacteria currently known as Mycobacterium tuberculosis. ST represents less than 1% of the total of cases of TB and accounts for 10% of extrapulmonary tuberculosis. In this case report we present the case of a middle aged man with symptoms mimicking prolapsed lumbar intervertebral disc with neurological deficit. Due to progressive neurology, the patient was managed with emergency surgery.

Discectomy Surgery on Prolapsed Lumbar Intervertebral Disc: Study in Prime Medical College Hospital, Rangpur, Bangladesh

Background: Basically, human backbone or spinal column is of a chain of bones also known as vertebrae. Spinal cord runs through the spinal column. Lumbar discectomy is a type of surgery to fix a disc in the lower back portion of human body. This surgery uses smaller cuts (incisions) than an open lumbar discectomy. We have very few proved data regarding the effectiveness of discectomy surgery on prolapsed lumbar intervertebral disc. The aim of this study was to assess the role of discectomy surgery on prolapsed lumbar intervertebral disc. Methods: This was a prospective observational study which was conducted at the Department of Orthopedics Surgery in Prime Medical College Hospital, Rangpur, Bangladesh during the period from January 2019 to December 2020. In total 38 patients with low back pain selected for discectomy surgery on prolapsed lumbar intervertebral disc were enrolled as the study population. This study was approved by the ethical committee of the mentioned hospital. Proper written consents were taken from all the participants before starting data collection. A pre-designed questionnaire was used in patent data collection. Radicular pain was observed by visual analogue score and disability status was done by using Oswestry disability index. By using modified Macnab criteria, outcome of the surgery was determined. All data were processed, analyzed and disseminated by MS Office and SPSS version as per need. Result: In our study as postoperative complication dural tear, superficial wound infection and foot drop were observed in 57.14% (Highest), 28.57% and 14.29% (Lowest) participants respectively. In analyzing radicular pain among the participants, we observed that VAS score had been reduced to 1.6±1.2 from 7.2±5.4 within one year of surgery which was 2.7±1.3 at immediate postoperative period. On the other hand, in analyzing Disability status among the participants we observed that, ODI index had been reduced to 10±1 from 64±8 within one year of ...........

Clinical outcomes and satisfaction in patients after lumbar microdiscectomy

Introduction: Lumbar disc herniation is a common cause of low back and radicular pain. Microdiscectomy is the recommended surgical technique for herniated lumbar discs at the moment. It has great success rates and little postoperative morbidity. We aimed to assess the clinical result and patient satisfaction of micro-discectomy in lumbar disc herniation patients. Methodology: This is a prospective observational hospital-based research of 26 patients who had micro-discectomy at the Regional Clinical Center of Neurosurgery and Neurology in Uzhhorod, Ukraine, during August and September 2021. The research excluded patients with recurrent prolapsed intervertebral discs, multiple level herniated discs, and disc surgery requiring stability. During surgery, the kind of prolapsed intervertebral disc, its level, and the duration of the procedure were recorded. Additionally, we recorded the duration of the patient's hospital stay and any complications. The visual analogue scale (VAS), the Oswestry Disability Index (ODI), and the MacNab score questionnaires were used to measure pain, disability, and patient satisfaction, respectively. Result: All procedures were performed on a single level using micro-discectomy. The mean age of the study population was 45.69 years. Micro-discectomy surgeries were performed in less than an hour in 69.2% of cases. The most often seen lumbar prolapsed intervertebral disc occurred at the L4-L5 level (57.7%). The most often seen kinds of prolapse were disc extrusion (30.8%) and disc sequestration (26.9%). The mean length of stay in the hospital was 3.96 days. After surgery, 57.7% of patients received an excellent rating on the Macnab's scale. There was a statistically significant difference between pre- and postoperative VAS and ODI scores (p<0.05). Conclusion: Overall 65.4% of patients had no postoperative complications. In these instances, a proper surgical technique might help avoid problems. Our findings demand additional investigation with bigger sample sizes and longer follow-up periods.

Spontaneous Recovery in Complete Foot Drop in a Case of Lumbar Disc Herniation: A Neurological Surprise

Lumbar intervertebral disc prolapse has been associated with radiculopathy and the sensory and motor changes that occur as the result of neural compression. The most important motor symptom is foot drop. Occurrence of foot drop in lumber protrusion of intervertebral disc prompts for the surgical treatment of the condition. Here, we report a case of a 32-year-male presented with unilateral foot drop, diagnosed as lumbar protrusion of intervertebral disc and recovered significantly without surgery. The good neurological outcome of the conservative management, in this case, puts the surgeon in a quandary whether to offer surgical management or not. A clinician should always remember this outcome before choosing the management plan for lumbar protrusion of intervertebral disc although rare.