RESUMO
Background: Prolapsed lumbar intervertebral disc is one of the most common problems encountered in medical practice. In orthopaedic practice patients having lesions of lumbosacral region causing low back pain with sciatica are not uncommon since the begdatainning of recorded history. To evaluate the fenestration and discectomy for prolapsed lumbar intervertebral disc by minimally invasive procedure.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. A 3cm incision was made in midline on back centering the desired space of the spine. The analysis was done according to the standard statistical analysis system. Prior to commencement of this study, the research protocol was approved by the Institutional Review Board of ethics of National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR).Results:Mean age was (35.98 ± 8.50) years with the range from 17 to 50 years. Out of 31 patients, 26 (83.87%) patients were male and 05(16.12%) were female. Out of 31 patients 01(03.22 %) had prolapse at the level of L3-L4, 23(74.19%) had at the level of L4-L5 and 07(22.58%) had at the level of L5-S1. In this series the most common causes of muscle weakness in EHL. Out of 31 patients, 22 (70.96 %) patients had weakness in EHL. 08 (25.80%) cases had weakness in FHL and both muscle weakness in 01 (3.22%). 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. Postoperative mean SLR was 81.94 ± 4.774 degree and range was 70?-90?, which was significantly improved. 29 (93.54%) patients had normal spine movement and 02 (06.45%) patients had restricted movement after 3 months of follow up. The minimum period of duration for follow up was 3 months and maximum duration of follow up was 12 months..Conclusions:By considering all aspects fenestration and discectomy is a better technique in the context of our country with the advantage of less tissue injury, good spinal function, smooth patient recovery, improve working status with early rehabilitation and maintain clinical efficacy.
RESUMO
Background: Prolapsed disc is the major cause of low backache with radiculopathy. Many different techniques, from extensive laminectomy to minimal invasive endoscopic surgeries have been described with aim to minimize the possibility of damage to other structures. Methods: Twenty patients with clinical symptoms and signs prolapsed disc having radiological confirmation by MRI were subjected to disc excision by fenestration technique. Results: The follow-up analysis as per Modified Mac Nab’s Criteria showed excellent results in 15 patients, good in 4 patients and fair in 1. Conclusion: Discectomy by fenestration offers sufficient and adequate exposure for lumbar disc excision. Advantages over conventional discectomy are smaller incision, lesser morbidity, shorter convalescence, early return to work and comparable overall results. It can even be performed in peripheral centers where recent microscopic and endoscopic facilities are not available.