Functional Outcome of Lumbar Fenestration and Discectomy in Patients with Lumbar Intervertebral Disc Prolapse

Karthik, A (2020) Functional Outcome of Lumbar Fenestration and Discectomy in Patients with Lumbar Intervertebral Disc Prolapse. Masters thesis, Government Mohan Kumaramangalam Medical College, Salem.


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AIM OF THE STUDY: To study the functional outcome of lumbar fenestration discectomy in patients with lumbar intervertebral disc prolapse. MATERIALS AND METHODS: This is a prospective study in patients with lumbar intervertebral disc prolapse in the age group of 20 –70 years admitted in Government Mohan Kumaramangalam Medical College and Hospital, Salem during the period from November 2017 to October 2019. The cases were evaluated using Japanese Orthopaedic Association Score. Those patients who do not responding to conservative treatment are evaluated and operated using the technique of lumbar fenestration discectomy. DISCUSSION: The mean age group of patients in our study was 42.9 years with a male preponderance. Thirty patients were included in the study. L4-L5 disc was the common level of disc prolapse. Sciatica was the most common symptom. One patient has excellent outcome, 24 patients have good outcome, three patients have fair outcome and two patients have poor outcome. RESULTS: Lumbar fenestration discectomy has proved to give good results when combined with proper patient selection and post operative physiotherapy. The results obtained are similar to results from technically demanding procedures like microdiscectomy. CONCLUSION: Lumbar disc prolapsed responds well to treatment by fenestration discectomy. Consistently good results (86.6%) in our study could be attributed to proper selection of cases and careful application of post op protocol. With proper case selection and good correlation between patient symptoms and imaging studies, good results can be obtained. Radicular pain was the most common presenting symptom and positive SLRT is the most common sign. Age, sex, duration of symptoms and neurological deficits were not found to have any statistical correlation in our study. The Japanese Orthopaedic Association low backache score is a very useful tool for the evaluation of functional outcome. Both subjective and objective measurements can be clearly recorded after proper evaluation and multiple studies have been compared by use of the same scoring system. Preoperative and postoperatively same score can be used and it is a added advantage. Small sample size is the only limitation of our study. The results our study were comparable to results obtained by microdiscectomy studies as shown in the table above. Though microsurgical technique is minimally invasive approach with a shorter hospital stay etc., the requirements and limitations of the study are many. It is technically more demanding procedure with a long learning curve for the surgeon and technically advanced equipments are needed for the procedure. On the other hand, fenestration discectomy is more cost effective and easily performed in all centres with minimal technical demand. Thus fenestration discectomy continues to be a gold standard technique for Indian scenario with results compared to results produced by advanced techniques like microdiscectomy.

Item Type: Thesis (Masters)
Additional Information: 221712355
Uncontrolled Keywords: Functional Outcome, Lumbar Fenestration, Discectomy, Lumbar Intervertebral Disc Prolapse.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 13 Feb 2021 16:47
Last Modified: 07 Apr 2021 07:15

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