Feasibility and Safety of Outpatient Lumbar Microscopic Discectomy in a Developing Country

Jaiswal, Ashish; Kumar, Satish; Reddy, Siva V.; Jaiswal, Parineeta

doi:10.31616/asj.2018.0268

Cited by 9 publications

(13 citation statements)

References 23 publications

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“…This corresponds to the study of Jaiswal et al In our series the, pre & post-operative Nurick score was 2.9 & 0.8 which was satisfactory for the patients[8].The mean ODI score was 54.6±12.8 & 10.2±3.3 respectively which is compitable to the study of Jaiswal et al The differences in the ODI scores were statistically significant between the pre and postoperative follow-ups (p<0.001). ODI scores below 40% were graded as good outcomes (success), whereas higher scores were considered partial or total failures.…”

supporting

confidence: 89%

Functional & Neurological outcome of Lumbar Microdiscectomy at L4/5 and L5/S1

Islam¹,

Saha²

2022

Prog Orthop Sci

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Objectives: To evaluate the Functional & Neurological outcome of Lumbar Microdiscectomy at L4/5 and L5/ S1 Background: Lumbar disc herniation (LDH) is the most common specific cause for low back pain (LBP). It is a degenerative process causing annular tear with extrusion of the nucleus pulposus through posterior midline or posterolateral aspect of the disc leading to compression of the thecal sac and nerve roots with radicular symptoms. Surgery is reserved for only those who are refractory for a fair trial of nonsurgical management for at least 6 weeks, need of decompression for conus and cauda equina compression, needing immediate attention. There have been various modalities of treatment that have evolved over the years. Micro-lumbar discectomy is one of the latest additions of surgical management modality. Materials & Method: Retrospectively we reviewed 30 cases from january 2019 to december 2021 in Bangabandhu Sheikh Mujib Medical university & other private hospitals in Dhaka, Bangladesh. All the patients had back pain & some neurological deficit with positive MRI findings, underwent lumbar microdiscectomy al L4/5 & L5/S1. Functional improvement was assessed by the ODI Score & categorized into excellent, good, fair & poor, Neurological improvement was assessed by the Nurick Score improvement of pain control by VAS score & overall functional assessment by modified Odom’s score. Results: Total number of patients was 30. Average age was 36 years (range 22-50). Average follow-up period was 9 months. Pre-operative ODI score was 54.6±12.8 & Post-operative score was improved to 10.2±3.3. In our series we have no chair bound or bedridden patients after surgery. The Pre-operative & Postoperative nurick score was 2.9 & 0.8 respectively. There was no difference in neurological outcomes comparing patients older and younger than 40 years. There was significant improvement in Pre-operative & Post- operative VAS score for leg pain was 6.90 ± 1.9 & 2.0 ± 0.8 respectively & for low back pain was 5.8±1.2 & 2.2±0.8 respectively. Conclusion: Lumbar Microdiscectomy is a safe & effective method to treat the patients with lumbar disc prolapse with shorter hospital stay & better prognosis with minimum & considerable complications.

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supporting

confidence: 89%

Functional & Neurological outcome of Lumbar Microdiscectomy at L4/5 and L5/S1

Islam¹,

Saha²

2022

Prog Orthop Sci

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“…38 A pilot study of 58 patients in a developing country reported a 100% success rate of same day discharge. 39 Our finding of greater residual back pain among the MIS group in our adjusted analysis may seem counter-intuitive, but it was previously reported by Arts et al in a secondary paper from their trial, in which serum creatine phosphokinase (CPK) and the cross-sectional area (CSA) of the multifidus muscle on magnetic resonance imaging were compared as measures of muscle injury. 40 They found no significant differences for CPK, but a significantly greater loss of relative CSA and significantly greater 1-year back pain among MIS patients.…”

Section: Relation To Prior Literaturementioning

confidence: 61%

Minimally Invasive Tubular Lumbar Discectomy Versus Conventional Open Lumbar Discectomy: An Observational Study From the Canadian Spine Outcomes and Research Network

Evaniew

Bogle

Soroceanu

et al. 2021

Global Spine Journal

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Study Design: Retrospective cohort study. Objective: We evaluated the effectiveness of minimally invasive (MIS) tubular discectomy in comparison to conventional open surgery among patients enrolled in the Canadian Spine Outcomes and Research Network (CSORN). Methods: We performed an observational analysis of data that was prospectively collected. We implemented Minimum Clinically Important Differences (MCIDs), and we adjusted for potential confounders with multiple logistic regression. Adverse events were collected according to the Spinal Adverse Events Severity (SAVES) protocol. Results: Three hundred thirty-nine (62%) patients underwent MIS tubular discectomy and 211 (38%) underwent conventional open discectomy. There were no significant differences between groups for improvement of leg pain and disability, but the MIS technique was associated with reduced odds of achieving the MCID for back pain (OR 0.66, 95% CI 0.44 to 0.99, P < 0.05). We identified statistically significant differences in favor of MIS for each of operating time (MIS mean (SD) 72.2 minutes (30.0) vs open 93.5 (40.9)), estimated blood loss (MIS 37.9 mL (36.7) vs open 76.8 (71.4)), length of stay in hospital (MIS 73% same-day discharge vs open 40%), rates of incidental durotomy (MIS 4% vs open 8%), and wound-related complications (MIS 3% vs open 9%); but not for overall rates of reoperation. Conclusions: Open and MIS techniques yielded similar improvements of leg pain and disability at up to 12 months of follow-up, but MIS patients were less likely to experience improvement of associated back pain. Small differences favored MIS for operating time, blood loss, and adverse events but may have limited clinical importance.

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“…K Vishwanathan et al noted from their study that the mean preoperative ODI which was 51.9+15.02 went down to 20.9+20.32 postoperatively at 6-to 12-week followup, which is in accordance with our study results [22] . The mean ODI score was 52.8±13.1 preoperatively in Jaiswal et al's study followed by 26.5±4.2 in the postoperative period, and 17.9±4.2 and 11.4±3.9 at the 1-and 6-month follow-ups, respectively [23] . In Hegde et al's study it was noted that the modified ODI scores preoperatively had a mean of 75 ± 11.85% which improved to 55 ± 9.18% at 6 weeks, 45 ± 9.37% at 12 weeks, and 36 ± 8.65% at 24 weeks [24] , which was comparatively slow reduction compared to our study.…”

Section: Discussionmentioning

confidence: 75%

Functional outcome of microscopic lumbar discectomy for the treatment of lumbar disc prolapse in tertiary care hospital in South India

K¹,

Ramanathan²

2020

Int. J. Orthop. Sci.

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Background: Microscopic lumbar discectomy has become the "gold standard" treatment for disc prolapse with early recovery of patients and quick return to work. Potential benefits include smaller incisions of the skin and fascia, less traumatic surgical procedure, reduced postoperative pain and hospital stay. We have evaluated the efficacy of microscopic lumber discectomy. Methods: This is a prospective observational study conducted in the Department of Orthopaedics in Karpaga Vinayaga Institute of Medical Sciences, Maduranthakam over a 2-year period from 2017 to 2019 on a convenience sample from patients undergoing micro lumbar discectomy for lumbar disc herniation. Functional outcome was evaluated periodically over a 14-week period with the Oswestry Disability Index (ODI). Results: A total of 30 subjects with a mean age of 41.73 years with a mean duration of low back pain of 10.13 months undergoing microscopic lumbar discectomy for lumbar disc prolapse were included in the study. On MRI Finding, 60.00% are noted to have extrusion, 33.33% protrusion and 6.67% sequestration. The mean duration of surgery is 1.28 hours, the mean blood loss is 153.33 mL, the mean duration of hospital stay is 3.17 days. The mean ODI has reduced from preoperative 73.67 ± 7.54 to 16 ± 3.28 at 14week follow-up, which is statistically significant (P Value <0.001). Conclusion:The current study concludes that microscopic lumbar discectomy for herniated lumbar disc is indeed "gold standard" with minimal blood loss and less hospital stay with a good functional outcome, leading to early return to work.

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Feasibility and Safety of Outpatient Lumbar Microscopic Discectomy in a Developing Country

Cited by 9 publications

References 23 publications

Functional & Neurological outcome of Lumbar Microdiscectomy at L4/5 and L5/S1

Functional & Neurological outcome of Lumbar Microdiscectomy at L4/5 and L5/S1

Minimally Invasive Tubular Lumbar Discectomy Versus Conventional Open Lumbar Discectomy: An Observational Study From the Canadian Spine Outcomes and Research Network

Functional outcome of microscopic lumbar discectomy for the treatment of lumbar disc prolapse in tertiary care hospital in South India

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