The Effectiveness of Surgery for the Symptomatic Prolapsed Lumbar Intervertebral Disc

Authors

  • Riaz -ur-Rehman Junior Registrar, Department of Neurosurgery Hayatabad Medical Complex, Peshawar Alnoor Drug Agency, Small Industrial Estate Kohat Road, Peshawar
  • SHAHID AYOOB Department of Neurosurgery, Hayatabad Medical Complex, Peshawar
  • MOHAMMAD RIZWAN Department of Neurosurgery, Hayatabad Medical Complex, Peshawar
  • Mewat Shah Department of Neurosurgery, Hayatabad Medical Complex, Peshawar
  • Mushtaq . Department of Neurosurgery, Hayatabad Medical Complex, Peshawar
  • Imran Khan Department of Neurosurgery, Hayatabad Medical Complex, Peshawar

Abstract

Aims and Objective: To know the effectiveness of surgery for the symptomatic prolapsed lumbar intervertebral disc in patients admitted in tertiary care hospital.
Materials and Methods: Subsequent to the approval from the ethical review committee, this descriptive study was conducted in neurosurgery department, Hayatabad Medical Complex, Peshawar from April 2009 to March 2012. All the patients were consented before enrolling into the study. Only those patients were included in whom straight leg raising sign was less than 60 degree and prolapsed disc was at L4-5 or L5 – S1 MRI. Those patients in whom the disc was at multiple levels or there was previous history of spine surgery, evidence of lumbar stenosis and higher level discs patients were excluded from this study. History, examination and MRI lumbosacral spine was done in all patients. Procedure was done in prone position under general anesthesia. Laminectomy and discectomy was performed .Patients were allowed to sit and mobilized after 12 hours of surgery and discharged mostly on 2nd postoperative day. The collected information was analyzed in statistical package of social sciences (SPSS) version 16.
Results: Out of 226 patients, 144 (63.72%) were male and 82(36.28%) were female. Mean age was 33.67 years with age range from 18–64. Most of the patients presented with leg pain i.e. n = 210 (92.92%) followed by back pain n = 190 (84.07%), numbness n = 181 (80.08%), motor deficit n = 30 (13.27%) and cauda equine n = 16 (7.07%). Post operatively only 14 (7.96%) patients had sciatica, backache was present in 110 (48.67%) patients, numbness in 150 (66.37) patients, motor deficit in 6 (2.65%) and cauda equine persisted in 7 (3.09%) patients. Commonest complication of the surgery was CSF leak which was present in 15 (6.64%) patients followed by discitis i.e. in 8 (3.53%) patients. Foot drop in 2 (0.88%) patients. Recurrent disc was seen in 18 (7.96%) patients.
Conclusion: Surgery in appropriately selected patients gives excellent results. It gives early and rapid pain relief. Conservative trial should be exhausted before embarking on surgery.

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Published

2014-06-30

Issue

Vol. 18 No. 1 (2014): January-June

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Original Articles

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The work published by PJNS is licensed under a Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). Copyrights on any open access article published by Pakistan Journal of Neurological Surgery are retained by the author(s).