First 30 Days Outcome of Conventional Discectomy for De Novo Lumbar Disc Herniation

Background: A lot of literature exists on almost every aspect of lumbar disc pathology. However, limited studies have looked at the early outcome of disc surgery and patient’s satisfaction with respect to pre-operative expectation. Objectives: Our study meticulously outlines the early outcome of pain and neurologic deficit after discectomy as well as assesses patients’ satisfaction in the early post-operative period. Patients and Methods: One hundred consecutive patients with de novo lumbar disc herniation operated in our department between January and December 2014 were prospectively followed-up. All patients were assessed pre-operatively and postoperatively on Days 1, 7 and 30 for low back pain, radiculalgia (using the Visual Analogue Scale), neurologic deficit and patient’s satisfaction by a verbal patient satisfaction index graded from 0-100%. Results: The mean age was 39.9±9.7 years and male to female sex ratio was 3:2. All patitients had low back pain (LBP), radicular pain in 88% andnerve root stretch signs in 91% of cases. Pre-operative motor deficit was found in 18% and Sensorydeficit in 29%.L45 herniated disc was the most common (66%), disc protrusion was the most frequent (59%).In seventy nine patients (79%)the fragment position was posterolateral. Severe sciatica was the most common indication for surgery (85%) and fenestration was done in 64% of cases. Remission of radicular pain was faster than for LBP and the difference was statistically significant (p 0.01).We had 14% post-op complications 7% of which were CSF leak managed with favorable outcome. The Mean patient satisfaction was 81.5% (±19.8 SD). Conclusion: Post operative alleviation of back pain is slower, variable and inconsistent than for sciatica. Thus the selection of patients for disectomy with predominantly low back pain should be cautioned by good clinical judgment. In preoperative consenting, patients should be informed on the slower remission of low back pain to limit postoperative dissatisfaction when results do not meet expectation.