Management of Prolapse Intervertebral Disc by Lumbar Discectomy by Interlaminar Fenestration – A Review of 30 Patients

Background: We are presenting 30 patients who had disc prolapse and surgically treated by interlaminar fenestration and disc excision. Methods: All of them had pain and sciatica for a period of three months prior to surgery. Initially all the patients were treated by conservative measures which failed in the cases which were taken up for the surgery. Results: The diagnosis in all the cases was made on Magnetic Resonance Imaging (MRI), additional computed tomography (CT) scan was done in the cases presenting with sciatica and claudication or suspected LCS. We encountered no difficulty by this approach for the localization of the disc and decompression of the nerve root. Conclusion: This method is a safe, effective and reliable method for treating patients of prolapse intervertebral disc (PIVD).

​Evaluation of the Outcome of Lumbar Disc Surgeries: Laminectomy Discectomy, Microlumbar Discectomy and Microendoscopic Discectomy

Background: The prevalence of back pain has been reported between 49% and 80%. Except for cases that require immediatesurgical intervention, the first-line treatment involves medical choices. 90% of attacks of sciatica respond to conservativemanagement. Surgical intervention when indicated involves discectomy and various operative methods include laminectomydiscectomy, microlumbar discectomy, and microendoscopic discectomy. The objective of this study was to evaluate theadvantages and disadvantages and outcome of the above-mentioned surgical operations for lumbar disc herniation (LDH) andthen, specifically, the outcomes for each of them using Odom’s criteria.Materials and Methods: A prospective study was carried out between April 2015 and April 2017 to compare the advantages/disadvantages and outcome of various surgical interventions in LDH, namely laminectomy discectomy (Group A), microlumbardiscectomy (Group B), and microendoscopic discectomy (Group C) with each group consisting of 30 patients. All patients wereadmitted as per inclusion criteria.Results: In each group of our study, the mean age and sex distribution were comparable and statistically not significant. Ourstudy showed the post-operative hospital stay and the need for post-operative analgesia was low for microendoscopic surgery,but on long-term evaluation with Odom’s criteria, laminectomy achieved better outcomes than other methods.Conclusion: Our study showed that microlumbar discectomy and microendoscopic discectomy have a better short-term outcomeas compared to laminectomy discectomy. However, long-term results are comparable.

Plain Radiological Measurement of Relationships Between Intervertebral Disc Space and Spinous Process

The mean values of the height, depth and lateral shifting of the spinous processes and the height of the intervertebral disc spaces of 100 patients were measured in the lumbar region. The application of microsurgical techniques in the operation for lumbar disc herniation clearly reduced the overall surgical trauma suffered by patient, but the spinous process might disturb the insertional course and multidirectional activities of the pituitary forceps due to a very small skin incision. The purpose of this study was to prove the relationships between intervertebral disc space and spinous process in the lumbar region. The results were as follows; 1) The height of the intervertebral disc space from L3-4 to L5-S1 intervertebral disc space was 12.63mm, 12.57mm and 11.71mm respectively. 2) The depth of the spinous process from L3 to L5 was 28.87mm, 27.87mm and 23.97mm respectively. 3) The lateral shifting of the spinous process from midline to the right side was 4.39mm, 4.35mm and 4.01mm at L3, L4 and L5 spinous process respectively and to the left side was 3.61mm, 3.70mm and 3.69mm at L3, L4 and L5 spinous process respectively. Conclusively, the lower part of the spinous process was overlapped above the intervertebral disc space at L3-4, L4-5 and L5-S1 intervertebral disc space. About 4mm of the lateral shifting of the spinous process was protruded to both right and left side in the insertional course(about 2-3cm) of the pituitary forceps. The spinous process might disturb the multidirectional activities and perpendicular insertion of the pituitary forceps. So, the removal of the spinous process to the midline was recommended to perform the complete removal of disc materials in microlumbar discectomy.

Microsurgical Operation of Herniated Lumbar Disc

The application of microsurgical techniques in the operation for lumbar disc herniation clearly reduces the overall surgical trauma suffered by the patient. A very small exposure of only about 2-3cm skin incision is necessary. No laminectomy is done. Flavotomy and an approach through interlaminar space is usually sufficient to remove the herniated disc by the microsurgical technique. Diagnosis is primarily made by spinal computed tomography(CT) scan. Between April and September 1982, 23 microlumbar discectomies were performed. Excellent recovery was 87% and good 13%. We have described our microsurgical technique and discussed its advantages.