MANAGEMENT OF DISC HERNIATION AT THE LUMBAR REGION THAT IS COMPLICATED WITH SPINAL STENOSIS USING SMALL INCISION FENESTRATION

Abstract

Objectives: The objective of the current study was to compare the alternative approach of smaller incision fenestration in managing lumbar disc herniation with spinal stenosis to previous conventional laminectomy procedures. Patients and methods: The current case-control study included a total of 290 patients who were represented by two groups. Those patients were complaining of herniation of the lumbar disc with a complication of stenosis of the lumbar segments. Patients in the study group were treated by a small incision fenestration approach, whereas patients in the control group were treated by posterior laminectomy and decompression. Those patients were selected retrospectively from the pool of patients visiting the orthopedic units of Adiwaniyah Teaching Hospital, Adiwaniyah province, Iraq. Results: Mean hospital stay of patients in the study group was lower in a significant way in comparison with that of patients in the control group, 6.03 ±2.08 days versus 8.07 ±3.13 days, separately (p< 0.001). Added to that, mean operative loss was significantly lower in a group of intervention in comparison with the control group, 52.12 ±5.17 ml versus 65.48 ±5.08 ml, respectively (p< 0.001). Added to that, mean operative time was lower in a significant way in the group of intervention in comparison with patients in the group of control, 62.62 ±3.09 minutes versus 87.09 ±3.47 minutes, respectively (p< 0.001). The mean“visual analogue score (VAS)” was significantly lower in the study group in comparison with the control group, 3.09 ±1.15 versus 6.08 ±2.17, respectively (p<0.001). A comparison of the mean “Japanese orthopedic association (JOA) score” for nerve function between the study group and the control group is shown in Figure 2. The mean “Japanese orthopedic association (JOA) score” was higher in a significant manner in the group of an intervention study in comparison with the control group, 27.15 ±3.07 versus 20.18 ±4.81, respectively (p< 0.001). Conclusion: Small incision fenestration techniques are associated with significantly less hospital stay, less duration of operation, less blood loss, less visual pain score and better nerve function in comparison with conventional laminectomy procedure. Keywords: smaller incision fenestration, lumbar disc herniation, spinal stenosis