Sivasenthil, A (2008) Surgical Management of Lumbar Intervertebral Disc Prolapse by Endoscopic Discectomy: A Study of 20 cases. Masters thesis, Madurai Medical College, Madurai.
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Abstract
INTRODUCTION: Back pain has plagued humans for many thousands of years. Low back pain is amongst the commonest human disabilities – a price man pays for the erect posture and every human being on the earth will experience back pain one time or the other in their life time. The increasing incidence is probably due to the present day hectic lifestyle due to rapid growth of industralisation, supplemented with poor posture as a occupational hazard especially in computer profession, wrong dietary habits leading to obesity and lack of regular exercises. It is commonly acknowledged today that derangements of intervertebral disc represents the great majority of cases of low back pain and sciatica. Intelligent treatment of lumbar disc prolapse must be predicted on a through knowledge of the natural history of this disorder. Many times surgical treatment fails because of inaccurate diagnosis and selection of wrong patients. The purpose of this study is to analyse the efficacy of endoscope in the treatment of lumbar intervertebral disc prolapse as one of the armamentorium of minimally invasive spine surgery with special emphasis on surgical exposure, blood loss, post operative pain, Radicular pain relief, Return to Daily activities, work and neurological recovery after surgery. Most of the studies showed that conservative treatment is the mainstay of treatment to start with and surgical treatment is indicated only when conservative treatment fails or in some other exceptional cases. AIM: The purpose of this study is to analyse the efficacy of endoscope in the treatment of lumbar intervertebral disc prolapse as one of the armamentorium of minimally invasive spine surgery with special emphasis on surgical exposure, blood loss, post operative pain, Radicular pain relief, Return to Daily activities, work and neurological recovery after surgery. MATERIALS AND METHODS: This study has been made with prospective analysis of 20 cases of lumbar intervertebral disc prolapse treated by endoscopic discectomy during the period from January 2007 to June 2007. In our study we used KARL STORZ endoscope designed by Dr. DESTANDAU, Neurosurgeon, Bordeaux, France. Prior to surgery the diagnosis was confirmed by CT/MRI and correlated by clinical, peroperative findings. All the patients were followed up from the time of presentations till the end of the study regularly from January 2007 to January 2008 and the average period of follow up was 8 months and one patient lost for follow up. Back pain, radiating leg pains, functional endurance and neurological features were the main aspects analysed since these were the main complaints of the patients. An objective evaluation regarding spinal movements, local tenderness, spasm, sciatic scoliosis, SLR and neurological signs also recorded in order to make it a comprehensive evaluation. RESULTS: The results of the treatments were grouped into four excellent, good, fair and poor according to relief of pain, working ability and clinical signs. Excellent - Complete relief of pain, full spinal movement, negative SLR, no work restrictions, no need for further treatment. Good - Complete or near complete relief of pain, minimal restrictions of work, require intermittent treatment. Fair - Moderate pain relief, moderate work restrictions, need further evaluation. Poor - No relief of pain, unable to work, requires further investigation and treatment. CONCLUSION: The financial pressures on the health care system and the push to reduce hospital stays have provided a strong impetus toward minimally invasive procedures in all surgical specialties including spine surgery. These procedures frequently are associated with decreased perioperative morbidity, decreased duration of hospital stay, and reduced costs. However, these types of procedures frequently required highly specialized equipment and training. Additionally, these procedures are often associated with unique and sometimes catastrophic complication.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Surgical Management ; Lumbar Intervertebral Disc Prolapse ; Endoscopic Discectomy ; Study of 20 cases. |
| Subjects: | MEDICAL > Orthopaedics |
| Depositing User: | Subramani R |
| Date Deposited: | 16 Sep 2017 15:31 |
| Last Modified: | 17 Sep 2017 05:48 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/2940 |
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