Study of outcome of early Versus delayed surgery in lumbar disc prolapsed: A prospective study

Puneeth, K (2016) Study of outcome of early Versus delayed surgery in lumbar disc prolapsed: A prospective study. Masters thesis, Madras Medical College, Chennai.

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Abstract

BACKGROUND & OBJECTIVES: Patients with lumbar disc herniation are commonly seen in our daily clinical practice and majority of patients respond to non-operative methods of management without requiring surgical intervention1. However, surgery is necessary for 10% of patients with incomplete resolution of symptoms. It has been suggested that the probability of symptoms resolving after lumbar discectomy depends on the preoperative duration of sciatica, which decreases progressively as the duration of pre-operative sciatica increases. However some have contradicted this impression. The objective of this study is to analyze if there is a predictive value of duration of sciatica on the functional outcome of lumbar discectomy using JOABPEQ and to study the effect of pre-operative duration of sciatica on the variables of JOABPEQ and conclude the advantages and disadvantages of early surgery and finally to come to a conclusion regarding the ideal time of surgery. METHODS: patients with sciatica with clinical signs suggestive of compression on the exiting nerve root confirmed on the mri and refractory to nonsurgical method of management, admitted in Rajiv Gandhi govt general hospital from aug 2014 to jan 2015 were studied. These patients were divided into 3 subcohorts. Subcohort A includes patients with duration of sciatica less than 4 months, subcohort B includes patients with duration of sciatica between 4 to 8 months, subcohort C includes patients with duration of sciatica more than 8 months. These patients underwent standard laminectomy and discectomy under antibiotic prophylaxis and standard post-operative regimen was followed. The patients were assessed preoperatively and post operatively at 6 months and 1 year with questionnaires. JOABPEQ was used to evaluate the effectiveness of the surgery. A difference of more than 20 between the preoperative value and post-operative value was considered effective. We have compared the preoperative scores and postoperative scores at 1 year. The 3 cohorts were assessed independently with questionnaire and compared with each other and analyzed statistically. RESULTS: Patients with preoperative duration of sciatica between 4 to 8 months showed better improvement than the other two cohorts with respect to low back pain, lumbar function, walking ability, social life function, except mental health scores which were better in patients with preoperative duration of sciatica less than 4 months. Patients with duration of sciatica more than 8 months showed worst outcomes. The complication rates, mean duration of hospital stay were more in patients with sciatica more than 8 months. CONCLUSION : This study concludes that there is definite significant relation between duration of sciatica and the functional outcome of primary lumbar discectomy. It also confirms that lesser the duration is better the outcome. From our study conclude that patients with duration of sciatica more than 8 months have unsatisfactory results following discectomy. Hence discectomy for lumbar disc herniation should be done before 8 months Since patients with duration of sciatica between 4 to 8 months have a better improvement than those less than 4 months conservative management can be continued up to 4 months after which surgery is necessary. The complication rates in this study was 9.3%.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Lumbar IVDP, Sciatica, Discectomy, JOABPEQ.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 16 Sep 2017 13:23
Last Modified: 16 Sep 2017 13:35
URI: http://repository-tnmgrmu.ac.in/id/eprint/3185

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