LUMBAR DISC FENESTRATION

EFFICACY IN PAIN RELIEF; FENESTRATION TECHNIQUE FOR DISC EXCISION

Abstract

Objectives: To know the efficacy of disc excision by fenestration method for the relief of lumbar radicular pain in patients with prolapsed intervertebral disc. Study Design: Descriptive study. Setting: Department of neurosurgery of Hayatabad Medical Complex, Peshawar. Period: October 2008 to September 2010. Patients and Methods: All those patients were included in whom straight leg raising (SLR) sign was less than 60 degree and prolapsed L4-5 or L5-S1 disc on MRI. Patients with multiple level discs, previous history of spine surgery, evidence of lumbar stenosis and cauda equina syndrome were excluded from this study. All patients were operated in knee-chest position under general anesthesia. Efficacy of disc excision was measured using Dennis pain scale. Findings were documented on the day of discharge. Statistical analysis was performed with SPSS (version 10). Results: One hundred and nine patients were studied. Sixty were male and fifty nine were female patients. Age rang was from 19 to 52 years with mean age 34.31 years. The most common level of involvement was L 4 -L 5 (n=67) followed by L 5 -S 1 (n=42) . Sixty five patients had left sided symptoms while forty four had right sided. Majority of patients presented in Dennis pain scale 4 i.e. 66.97% (n=73). Twenty patients (18.36%) were in P3 and 16 patients (14.67%) were in Dennis pain scale 5. Complete pain relief (P1) , three weeks after disc excision ,was achieved in 90 (82.57%) patients .Fourteen patients(12.85%) were in P2 and five(4.58%) patients in P3 according to Dennis pain scale. No patients in this study deteriorated after surgery. Conclusions: Surgical treatment provides quick pain relief in selected patients with prolapsed intervertebral disc. Fenestration with disc excision is quite a reasonable method to surgically treat the indicated cases of prolapsed disc. Fenestration offers complete visualization of nerve root and complete removal of the offending disc. This procedure does not need greater know-how, expertise in instrumentation and techniques.