LUMBAR DISC FENESTRATION

Know the efficacy of disc excision by fenestration method for the relief of lumbar radicular pain in patients withprolapsed 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 spinesurgery, evidence of lumbar stenosis and cauda equina syndrome were excluded from this study. All patients were operated in knee-chestposition under general anesthesia. Efficacy of disc excision was measured using Dennis pain scale. Findings were documented on the day ofdischarge. Statistical analysis was performed with SPSS (version 10). Results: One hundred and nine patients were studied. Sixty were maleand 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 L4 -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 patientspresented 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 andfive(4.58%) patients in P3 according to Dennis pain scale. No patients in this study deteriorated after surgery. Conclusions: Surgical treatmentprovides quick pain relief in selected patients with prolapsed intervertebral disc. Fenestration with disc excision is quite a reasonable method tosurgically treat the indicated cases of prolapsed disc. Fenestration offers complete visualization of nerve root and complete removal of theoffending disc. This procedure does not need greater know-how, expertise in instrumentation and techniques.