LUMBAR DISCECTOMY

COMPARATIVE STUDY OF ENDOSCOPIC VS FENESTRATION OPERATION

Abstract

Background: Discectomy is the standard treatment for lumber disc disease. Fenestration operations involved lot of tissue dissection and so the complications. Instead the endoscopic discectomy involved less tissue dissection but limited exposure. Objectives: The objectives of this study were to compare the outcome of endoscopic discectomy and fenestration discectomy interms of relieve from symptoms and complications. Study Design: Analytic study. Place and duration of study: Neurosurgical unit Bahawal Victoria hospital Bahawalpur, from Feb 2010 to Aug 2010. Patients and Methods: Forty cases fulfilling the inclusion criteria were selected. Efficacy of procedure was determined by improvement in Denis pain scale, Macnab’s criteria and straight leg raising (SLR) improvement. Results: Forty patients divided in two equal groups. Patients of group A underwent fenestration and Group B endoscopic discectomy.60%of patients had left sciatica while 40% of patients had right sciatica. According to Denis pain scale 10% patients had moderate pain, 30% had severe pain and 60% had constant pain. Straight leg raising test showed, 50% patients had less than 30O SLR, 30%patients showed SLR of 31̊ to 40̊ and 20%patients had SLR more than 40O. MRI findings were disc bulging, protrusion and rupture. Considering SLR, Denis pain scale and Mcnabs criteria of pain control there was no clinical difference found between the two operative procedures except in two patients in group B when open discectomy had to be performed. Conclusions: MED is a safe and effective mode of treatment for low back pain in patients with lumbar disc herniation.