MANAGEMENT OF DISC HERNIATION AT THE LUMBAR REGION THAT IS COMPLICATED WITH SPINAL STENOSIS USING SMALL INCISION FENESTRATION
DOI:
https://doi.org/10.52764/jms.24.32.1.14Keywords:
smaller incision fenestration, lumbar disc herniation, spinal stenosisAbstract
Abstract
Background: Herniation of the lumbar intervertebral disc is regarded as the leading cause of sciatica worldwide, though, the acute attacks of sciatica are mostly managed by conservative measures; nevertheless, the surgical managements provide fast relief of pain in cases where surgery is the choice. The previous research indicated that the relief of pain, better functional restoration, and patient satisfaction were greater in patients who underwent surgical operations than the patients who were treated conservatively.
Aim of the study: The objective of the current study was to compare the alternative approach of smaller incision fenestration in managing lumbar disc herniation with spinal stenosis to previous conventional laminectomy procedures.
Patients and methods: The current case-control study included a total of 290 patients who were represented by two groups. Those patients were complaining of herniation of the lumbar disc with a complication of stenosis of the lumbar segments. Patients in the study group were treated by a small incision fenestration approach; whereas patients in the control group were treated by posterior laminectomy and decompression. Those patients were selected retrospectively from the pool of patients visiting the orthopaedic units of Adiwaniyah Teaching Hospital, Adiwaniyah province, Iraq.
Results: Mean hospital stay of patients in the study group was lower in a significant way in comparison with that of patients in the control group, 6.03 ±2.08 days versus 8.07 ±3.13 days, separately (p < 0.001). Added to that, mean operative loss was significantly lower in a group of intervention in comparison with the control group, 52.12 ±5.17 ml versus 65.48 ±5.08 ml, respectively (p < 0.001). Added to that, mean operative time was lower in a significant way in the group of intervention in comparison with patients in the group of control, 62.62 ±3.09 minutes versus 87.09 ±3.47 minutes, respectively (p < 0.001). The mean “visual analogue score (VAS)” was significantly lower in the study group in comparison with the control group, 3.09 ±1.15 versus 6.08 ±2.17, respectively (p <0.001). A comparison of the mean “Japanese orthopaedic association (JOA) score” for nerve function between the study group and the control group is shown in Figure 2. The mean “Japanese orthopaedic association (JOA) score” was higher in a significant manner in the group of an intervention study in comparison with the control group, 27.15 ±3.07 versus 20.18 ±4.81, respectively (p < 0.001).
Conclusion: Small incision fenestration technique is associated with significantly less hospital stay, significantly less duration of operation, significantly less blood loss, significantly less visual pain score and significantly better nerve function in comparison with conventional laminectomy procedure.
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