الفهرس | Only 14 pages are availabe for public view |
Abstract Low back pain is one of the most common reasons for people to seek medical help; its prevalence ranges from 60–90%. Lumbago is a general term referring for low back pain while Sciatica is a name given to pain in the area of distribution of the sciatic nerve (L4 to S3) which is commonly felt in the buttock and over the poster lateral aspects of the leg. The most common cause of sciatica is lumbar disc herniation which may result from acute traumatic injury or from preceding degenerative changes within the lumbar disc. The degenerative disc disease (DDD) occurs even in asymptomatic patients, but for about 10% of the population it results in permanent chronic pain and disability. The lifetime prevalence of a lumbar disc herniation is approximately 2%. The natural history of sciatica secondary to lumbar disc herniation is spontaneous improvement in the majority of cases. Among patients with radiculopathy secondary to lumbar herniation, approximately 10-25% (0.5 of the population) experience persistent symptoms. First-line treatments for sciatica are nonsurgical and may consist of physical therapy, pharmacologic therapy, and/or epidural steroid injection. Acute sciatica symptoms subside in most patients independent of treatment. For symptoms that are resistant to initial conservative treatments, continued conservative care or lumbar discectomy to remove the offending herniated disc material may be considered. Lumbar microdiscectomy (MD) and open-discectomy (OD) are commonly performed surgical procedures for patients with lumbar disc herniation. Mixter et al. were the first to describe pitfalls of laminectomies and later in 1978 Caspar and Williams initially reported the technique of lumbar MD, which slightly contributes to a relatively smaller incision, less soft tissue damage, therefore reduced postoperative pain, early discharge from hospital and return to work compared to OD. The aim of this work was to compare the benefits and harms of minimally invasive discectomy versus ordinary(conventional) discectomy for the management of lumbar intervertebral discopathy. In our study, we focus on microscopic discectomy from the different modalities of minimally invasive techniques. This cross-sectional study was conducted at Menoufia University Hospitals & Al-Haram Specialized Hospital including 72 Patients with single level disc prolapse (L4-L5 or L5-S1). The patients were divided into two major groups (36 patients for each group); the 1st one undergone conventional (ordinary) discectomy; the 2nd group undergone minimally invasive discectomy (In our study we chosed microscopic discectomy). All patients included in this study were subjected to all of the following: Full history taking: Personal history: Age, residence, work nature. Complains onset, nature (pain, site, radiation, effect on daily work, pressure symptoms e.g., Incontinence). Medications used and frequency. Physical examination included general condition, neurological examination and all patients were subjected to assessment of the pain using VAS score. Investigations included routine pre-operative Laboratory investigations: to evaluate patients’ fitness for the operative procedure (CBC, ESR,CRP,INR, RBS, kidney functions, Liver functions, viral markers). Radiological included dynamic X-ray to exclude instability, C-T lumbosacral spin and MRI lumbosacral spine . |