Arun S.1 , Raj S. Chandran2
BACKGROUND The incidence of lumbar intervertebral disc prolapse (LDP) is increasing in the current practice of neurosurgery. But prospective studies to assess the risk factors in the final outcome of surgical procedures adopted while treating LDP are not many. We wanted to analyze the risk factors and their role in the prognosis and functional improvement after surgery in patients with Lumbar Disc Herniation. METHODS 200 patients with LDP subjected to different surgical procedures were studied prospectively in the Department of Neurosurgery, in a tertiary teaching hospital during the period of April 2017 to March 2019. The demographic profile, risk factors and the surgical procedures adopted were noted. The Macnab criteria were used to determine the clinical outcome after surgery. All patients were followed for a period 6 months postoperatively for the presence of complications and final functional outcome after surgery. RESULTS Mean age of the patients was 44.7 ± 4.65 years. Males were 113 / 200 (56.50 %) and females were 87 / 200 (43.5 %). Low back pain was present in 187 (93.50 %) patients, radicular pain was seen in 171 / 200 (85.5 %) patients. L4 - L5 interspace was involved in 122 / 200 (61.0 %) patients; disc was extruded in 91 / 200 (45.5 %) patients; disc protrusion was observed in 81 / 200 (40.5 %) patients. According to Macnab criteria, in this study excellent outcome was seen in 129 / 200 patients (64.5 %); the outcome was Good in 56 patients (22.5 %), Fair in 8 (4 %) patients, and Poor in 7 cases (3.5 %). Better surgical outcomes were associated with younger patients (p < 0.001), non-diabetics (p = 0.024), absence of bowel and bladder involvement (p < 0.001), protruded disc prolapse (p = 0.036), and disc prolapse precipitated by lifting inappropriate weight (p = 0.001). 85.4 % of the MIS group had excellent outcomes, when compared to 39.1 % in the laminectomy group (p - < 0.001). CONCLUSIONS Lumbar Disc Herniation was commonly observed in the middle age with a male predilection. Risk factors like age, overweight, high BMI and diabetes mellitus had poor outcomes. Surgery for LDH was safe with a success rate of (92.5 %).
