Riaz-ur Rehman, Mushtaq, Azmatullah Khattak, Farooq Azam, Waqar Alam.
Efficacy of Discectomy by Fenestration Technique in Lumbar Radicular Pain.
Pak J Neuro Surg Jan ;14(2):131-4.

Objectives: To know the efficacy of disc excision by fenestration method for the relief of lumbar radicular pain in patients with prolapsed intervertebral disc.Material and Methods: This descriptive study was conducted in the department of Neurosurgery of Hayatabad Medical Complex, Peshawar, from October 2008 to September 2010. All those patients were included in whom straight leg raising (SLR) sign was less than 60 degree and prolapsed disc at L4 – 5 or L5 – S1 levels on MRI. Patients with multiple level discs, previous history of spine surgery, central disc, evidence of lumbar stenosis and cauda equina syndrome were excluded from this study. All patients were operated in prone position under general anesthesia. Efficacy of disc excision was measured by improvement in Dennis pain scale post operatively. Findings were documented in separate semi structured proforma on the day of discharge and stored in our computer database. Statistical analysis was performed with SPSS (version 10).Results: One hundred and nine patients were studied. 66 (55%) were male and 59 (45%) were female patients. Age rang was from 19 to 52 years with mean age 34.31 years. The commonest level of involvement was L 4 -L 5 in 67 (61%) followed by L5 – S1 in 42 (89%). Sixty five patients had left sided while forty four had right sided symptoms. Majority of patients presented in Dennis pain scale 4 i.e. 67% (n = 73). Twenty patients (18%) were in P3 (Moderate pain, occasionally medications with no interruption of work or activities of daily living) and 16 patients (15%) were in Dennis pain scale 5 (Constant, severe pain; chronic pain medications) post-operatively. Complete pain relief (P1), at the time of discharge from hospital, was achieved in 91 (83%) patients. Fourteen patients (12.26%) were in P2 and 4 (3.58%) patients in P3 according to Dennis pain scale. No patients in this study deteriorated after surgery.Conclusion: In selected patients with prolapsed intervertebral disc, surgical treatment provides quick pain relief. Fenestration with disc excision is quite a reasonable method to surgically treat the indicated cases of prolapsed disc. Fenestration offers complete visualization of nerve root and complete removal of the offending disc. This procedure does not need greater expertise, sophisticated instrumentation and techniques.

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