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Indian Journal of Orthopaedics Surgery


Laminotomy Discectomy Versus Conservative Management for Lumbar Disc Prolapse: Short Term Results


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Author Details: Maruthi CV, Shivanna

Volume : 2

Issue : 1

Online ISSN : 2395-1362

Print ISSN : 2395-1354

Article First Page : 102

Article End Page : 109


Abstract

Background & Objectives: Back pain, the ancient curse is now appearing as a modern epidemic. 80% of the population is affected by this symptom at sometime of life. Impairments of the back and spine are ranked as the most frequent cause of limitation of activities in people of all age groups. Lumbar discs are responsible for well over 90% of all organic symptoms attributable to low backache. Here we have done a clinical study, which includes sixty cases of lumbar intervertebral disc prolapse in the age group of 20 to 70 years, irrespective of sex, with clinical symptoms, signs and radiological evidence treated either conservatively or surgically with discectomy in the Department of Orthopaedics at our institute. All cases were followed up and functional results were analysed. The objective was to study the clinical presentation, evaluate outcome of both conservative and surgical management and to compare the results of both modes of treatment.
Methods: Out of 60 patients included in the study, 30 were treated conservatively & another 30 underwent laminotomy discectomy in the Department of Orthopaedics at our institute between October 2007 & September 2013. The short-term follow-up results in patients who were followed up for a minimum of 6 months after treatment were evaluated by using the Japanese Orthopaedic Association scoring system through clinical examination and questionnaire.
Results: Prevalence of disc prolapse was in age group of 20 to70 years, while peak incidence was between 30-40 years of age. Incidence of disc prolapse in males was almost twice as much as in females (in our series 65% male cases were noted). 56.67% cases had disc prolapse at L4-L5 level, which being the commonest site of disc prolapse followed by L5-S1 of about 41.67% and 1.67% at L3-L4 level. In the short term follow-up of 6 months, the outcome was good in 90% & excellent in 6.67% of surgically treated patients with 3% complication rate. Conservatively treated group of patients showed 46.67% good, 43.33% fair & 10% poor results.
Interpretation & Conclusion: Short term outcome of standard discectomy in our study was favourable and comparable to other studies. With the execution of appropriate selection criteria and appropriate pre & post treatment planning, a good to excellent outcome was seen in nearly 97% in surgical study. In conservatively treated group, 90% patients showed fair to good result. Therefore lumbar discectomy is still a simple, safe & effective treatment with rapid relief for patient while conservative treatment if given to properly selected cases also gives effective results. Patients undergoing surgery for lumbar disc herniation achieved greater improvement in outcome than conservatively treated patients.

Key Words
: Conservative, Disc prolapse, Discectomy, JOA, Laminotomy