Background: Epidural Fibrosis (EF) is a risk factor for Failed-Back Syndrome (FBS) and inadequate symptom alleviation following lumbar disc surgery. There is an increase in arachnoiditis and dural tears after reoperation due to the unfavourable consequences, which compromise the result and make the nerve roots vulnerable to electrical field harm. It is possible that Suction Drains (SD) used to remove collections from the surgical site significantly contribute to the prevention of EF.
Aim: This research looked at the results and risks of dorso-lumbar disc laminectomy for herniated discs.
Methods: One hundred patients with symptomatic unilateral or bilateral single-level (L4-5 or L5-S1) lumbar disc herniation were recruited at the Department of Neurosurgery for disc surgeries. Of these patients, 65 were males and 35 were women. Researchers used a cross-sectional design. When the SD and barrier were not implanted, the results were compared to those without. Using single-level midline surgery, which was limited to the L4, L5 or L5-S1 levels, all surgeries were performed in a prone posture. In order to expose the nerve root and dural sac, techniques such as discectomy, decompression inter-laminar laminectomy, micro-, hemi- or formal laminectomy were used. A further 24-36 hours after the procedure, the SD persisted. During the appointment, the patient had a neurological evaluation and clinical evaluation with an emphasis on the patient’s strength, reflexes, sensibility and pain levels in relation to the operated level. It also covered range of motion, discomfort in the low back and radicles, pain associated with physical activity and the results of Straight Leg Raise (SLR) tests, which included flexion (normal 60°), extension (normal 25°) and lateral flexion (normal 25°). We also measured the length of pain alleviation and the degree of the pain. As part of the follow-up after one year, an MRI was performed.
Results: When comparing the groups according to neurological tests, the frequency and severity of adverse events and wound healing features, no statistically significant differences were found. Fifty patients underwent surgery at the L4-5 level and fifty more were operated on at the L5-S1 level. No new neurological impairments or problems were noted. The average amount of time spent in the hospital was five days. In comparison to the results in the beginning, more patients reported feeling better (Table 1,2). A decrease in pain alleviation of more than 50% was seen in both groups. A total of 97% of patients in the therapy group reported substantial improvement in their pain levels at the 3-month, 6-month and 1- to 3-year post-operative follow-up evaluations. All members of the study group had their values compared to their baseline levels before surgery and again after the procedure. At the one-year point, there was a tendency towards better results in the therapy group. Lots of people in the therapy group had long-term relief, along with better pain and functional status, according to the criteria that says short-term relief is less than six months and long-term relief is more than six months.
Conclusion: Patients benefited greatly from suction drainage in terms of both immediate and delayed pain relief, functional improvements and SLR performance, regardless of whether it was administered alone or in combination with other therapies. Using MRI, we found that the ejection percentage was significantly lower when we used combination techniques. There was a robust clinical association between results and the degree of EF as measured by the MRI grading system.
Keywords: Dorso-Lumbar Discs Laminectomy; Disc Herniation; Epidural Fibrosis; Failed-Back Syndrome; Suction Drains
