Author(s): Sudheer Urampath1, Dominic Kuriakku Puthur2, Jayaprakash Chundarathil3
Intervertebral Disc Prolapse (IVDP) is a very common cause for low backache in younger population. When conservative treatment fails or when patient develops complications like neurological deficit, then the treatment is surgical discectomy. Open laminectomy and microdiscectomy are the modes of surgical interventions for such patients. There is a lot of morbidity for open laminectomy when compared to microdiscectomy to assess the functional outcome of patients underwent lumbar microdiscectomy.
A prospective study was done among 30 patients with Intervertebral Disc Prolapse (IVDP) who did not respond to conservative treatment were undergone the surgical procedure microdiscectomy. The patients were re-evaluated for pre and postoperative neurological deficit and postoperative pain relief at 1 week, 6 weeks, 6 months, 12 months and 24 months after surgery.
Out of 30 patients in 15 (50%) patients, microdiscectomy was done in hip flexion and in the remaining half (15 patients) it was done without hip flexion. There were 18 men and 12 women with a mean age of 39.4. All patients 30 (100%) is presented with preoperative neurological impairment had a positive Lasegue sign, 20 (66.67%) had motor deficits and 18 (60%) had sensory deficits. In this study group, the vertebral levels mainly affected were L4-L5 in 18 (60%) patients and L5-S1 in 12 (40%) patients. After microdiscectomy, motor deficit was reduced from 66.67% to 20% out of 30 patients by the end of one year. Similarly, a reduction in sensory deficit was also seen from 60% to 20%. Pain relief was also found to be excellent in 86.6% patients at the end of 24 months.
Early postoperative mobilisation and earlier pain relief are the most important advantages of this novel technique. Lesser blood loss, low surgical time, least destabilisation of spine are other merits of this procedure and can be recommended as the gold standard surgical method for patients with IVDP who were failed with conservative treatment method.