Successful clinical outcomes of microscopic discectomy in patients with lumbar disc herniation -correlation of clinical and radiological factors

• Author Details:   
• Ravikumar TV
• Sathish Kumar T
• Vinay Jain K
• Mahesh M

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Study Design: Prospective longitudinal study.
Objective: The aim of our study article was to find the factors related to successful outcomes with clinical factors like level, side of disc herniation and type of herniation in patients undergoing the microscopic discectomy.
Methods: One hundred and seven patients between the ages of 20 years to 45 years, who have undergone single-level lumbar micro discectomy in our institution, operated by a single surgeon were taken in to the study and were followed prospectively for 2-years period. Patients with failed conservative management either with rest, physical therapy and epidural/transforaminal steroid infiltration were included with in the age group of 20-45 years. Pre and Postsurgical visual analog scale, pre and post Prolo score, patient satisfaction and return to duty along with the need of additional surgery and neurological recovery were noted in relation with the level of the disc herniation, side of disc herniation and the type of disc herniation stenosis.
Results: Patients with L5-S1 Disc herniation had better Visual Analog Scale score compared to L4-L5 level. Sequestered disc herniation had better clinical outcomes than other types. Patients with L5-S1 Disc herniation had better Visual Analog Scale score compared to L4-L5 level. Sequestered disc herniation had better clinical outcome compared to contained discs. During the final follow up, patient’s return to unrestricted duty was seen in 85%, 10% in restricted duty and 5% have changed their previous profession.
Conclusion: Microscopic discectomy is a well-known procedure for the lumbar disc herniations and one of the most common spinal procedure performed in today’s world. Patients with L5-S1 disc herniation had better Visual Analog Scale score and Prolo score compared to L4-L5 level. Sequestered disc herniation had better clinical outcomes. Patient with left side disc herniation had better outcomes and lesser complication rates. This factor might be due to predominant right handedness with better instrument guidance and root retraction during the surgical procedure.

Keywords: Microdiscectomy, VAS score, Prolo score, Disc herniation level, Side of disc herniation