Dr. Siddharth Katkade is a highly skilled, world wide trained and dedicated Spine Surgeon with over 10+ years of experience in field of specialised Spine Care and Orthopaedics.
- Phone:+91 88507 73095
- Email:bombayspineclinic09@gmail.com
Dr. Siddharth Katkade is a highly skilled, world wide trained and dedicated Spine Surgeon with over 10+ years of experience in field of specialised Spine Care and Orthopaedics.
BACKGROUND: As per European studies the incidence of a herniated disc is about 5 to 20 cases per 1000 adults
annually and is most common in people in their third to the fth decade of life, with a male to female ratio of 2:1. The
estimated prevalence of symptomatic herniated disc of the lumbar spine is about 1-3 percent of patients. It’s proved that majority of cases of
Lumbar disc herniation recovers with conservative trial but the exact proportion of patients recovering from conservative trial is not clear.
AIM: To study the patient recovery ratio from conservative to surgical management of lumbar disc herniation and its co relation with age.
MATERIAL AND METHODS: In this prospective study all the adult (above 18 years) age group presenting with lumbar disc lesion and
canal stenosis admitted in orthopaedic department of Tertiary Care Centre satisfying inclusion were taken for study after obtaining their
consent. All these patients where started with conservative trial and followed up on OPD basis monthly and according to the clinical
recovery decision of continuing conservative trial or operative management was taken after minimum trial of 4-6 months . RESULTS: Out
of 120 patients only 30 (25%) patients needed operative intervention and rest 90 (75%) were managed by conservative line of management.
In 20-40 age group – 78% managed conservatively and 22% managed operatively. In 40-60 age group – 72% managed conservatively and
28% managed operatively. In ≥60 age group – 78% managed conservatively and 22% managed operatively. CONCLUSION: This study
shows the patient recovery ratio from conservative to surgical management of lumbar disc herniation is 3:1. All patients with lumbar disc
herniation should undergo conservative trial initially. Only if conservative trial fails or patient with persistent disabling pain or neurological
decit are subjected to operative intervention. Relatively young patients (20-40) age group had majority of them managed conservatively.
The more common age group affected was 40 to 60 years age group with the average of 44.9 years with signicant male predominance and
also this age group had slight higher percentage of operative rate compare to other two groups.
lumbar disc lesion, epidemiology, conservative trial, minimal invasive lumbar discectomy.
Humans are the sufferers of back and leg and pain since the history. Theancient cures, of back pain are now appearing as a modern international epidemic. In entire lifespan upto 80 % of people are affected by this symptom at some time. The most frequent cause of limitation of activity in people younger than +5 years is impairments of the back and spine as by the national center for health statistics. In otherwise healthy people in the 3rd and 4th decades of life intervertebral disc disease and disc herniation are most prominent. It accounts for a majority of cases of low backache in clinical practice
and also a major contributor of limitation in day to day activities. In 1934, Mixter and Barr published their study that concluded that the suffering caused by sciatic pain can be improved by laminectomy with
decompression and extraction of herniated lumbar disc27. Since then increasing number of patients have been operated upon for this disorder. “Gold standard” for operative intervention in patients with herniated lumbar discs whose conservative treatment has failed is now the Open discectomy. Discectomy rst reported by Mixter and Barr1 (1934) has changed the management of lumbar disc herniations. Kambin and Savitz 2 (1973) introduced the concept of endoscopic lumbar discectomy. Caspar3 (1977), Yasargil 4 (1977) and Williams5(1978) added renements in approach with the use of microsurgical technique. Foley and Smith6 (1997) introduced an operative endoscope with the tubular system terming it “Endoscopic Discectomy”. As an alternative to the endoscope, Foley et al. (2003) modied the tubular retractors to include a microscope, which is termed “Micro Endoscopic Discectomy” (MED). The term is used interchangeably for describing the discectomy procedure utilizing tubular retractors either with an
endoscope or a microscope. 7 Recent prospective randomized control trials (RCTs) have found a benet of surgery for patients when conservative therapies fail. 8 9 10 11 Discectomy performed open or
with an operating microscope remains the standard surgical
management.12 13 14 Tubular retractor system15 16 17 is being increasingly used now. The potential benets of to this technique include less muscle and local damage, better cosmesis,18 19 20
decreased pain and operative time and faster recovery after surgery.21 22 On the other hand, open surgery includes extensive retraction and dissection of paraspinal muscles, longer operative time, longer