Study of 150 cases of microdiscectomy
Dr Vivek Vaidya, MBBS
National Neurosurgical Referral Centre
Bir Hospital, Kathmandu
Surgical options for lumbar disc herniation (LDH) ranges from open lumbar laminectomy and discectomy to percutaneous discectomy, however minimally invasive open lumbar discectomy is being widely practiced by neurosurgeons with best results for last two decades which was initially introduced by R.W.Williams in 1980s.
This is a retrospective study of 150 cases who underwent minimally invasive open lumbar discectomy for lumbar disc herniation at Bir hospital, Kathmandu, Nepal from B.S 2063 to 2067. This study is aimed at analyzing the outcome of lumbar disc herniation after minimally invasive open lumbar discectomy. Surgery was indicated for those patients who did not improve with conservative treatment (90%), and who had progressive neurological deficit (5%).
Out of 150 cases, there were 101 males and 49 females with majority (42%) of cases falling in the age group of 30-39 years and 20% falling in either 20-29 or 40-49 years age group. Of 150 cases, 98% presented with low backache and radicular pain and 20% had focal deficit. In all the cases, MRI was the preoperative diagnostic tool. Commonest level involved was Lumbar (L) 4/5 (48%) followed by L5/S1, (42%), and high LDH was found in 8 patients. Multiple level LDH was found in 5 patients.
In 80% of patients, radicular pain subsided postoperatively and they were mobilized 12 hours after the surgery and discharged the same day. Complications include dural tear (5), discitis (8), increase pain (2), and postoperative death in 1 patient. And more than 80% of the patients were able to re-join their previous job.
Follow up period after 6 month of surgery revealed more than 80% of the patients were pain free and less than 5% had persistent sciatica and other discomfort.
Laminectomy, LDH, minimally invasive open lumbar discectomy