Outcome of Prolapse Lumbar Intervertebral Disc (PLID) Surgery: A Study at a District-Level Private Hospital in Bangladesh

Author(s): Dr. Md. Mahamudul Hasan, Prof. Dr. Md. Shah Alam, Dr. Sarwar Jahan, Dr. Abdullah Al Mamun Chowdhury, Dr. Sharif Ahmed Junayed, Dr. Md. Mahabubur Rahman Khan, Dr. Md. Ziaul Hasan

Background:

Lumbar disc herniation (LDH) is the most common specific cause of low back pain (LBP). It is a degenerative process as well as acute trauma causing annular tear with extrusion of the nucleus pulposus through the posterior midline or posterolateral aspect of the disc, leading to compression of the thecal sac and nerve roots with radicular symptoms. Disc prolapse often affects the lumbar region, typically at L4/L5 or L5/S1. Individuals with occupation of prolonged standing (eg- Traffic Police), prolonged sitting (Desk job) weightlifters, and those with multiple jerking trauma (eg-Bikers) are at higher risk. Initial symptoms include backache and sciatica, with possible muscle weakness, Bowel and Bladder involvement in Cauda Equina compression. Diagnosis based on a typical History of LBP with Radiculopathy, physical tests like straight leg raising, and DRE should be done in Cauda Equina Syndrome. Differential diagnoses include tuberculosis, spinal stenosis, and vertebral tumours. MRI will confirm the diagnosis. Dynamic view X-ray will be required to see the instability. Surgery is reserved for those who are not responding to nonsurgical management for at least 6 weeks, but for Cauda Equina Syndrome, surgery should be done immediately. Surgical management of lumbar intervertebral disc prolapse (PLID) is crucial for alleviating pain and restoring function. In Bangladesh, evaluating surgical outcomes is essential.

Aim of the study:

The study aimed to explore the various demographic aspects of patients who have undergone PLID surgery, focusing on clinical presentation, complications, and surgical outcomes.

Methods:

This prospective observational study was conducted in the different private hospitals in Satkhira, Bangladesh, from 2020 to 2021. A total of 112 patients undergoing PLID surgery were enrolled and analyzed in this study. Advanced imaging techniques like MRI confirmed diagnoses, and participants were selected through purposive sampling. Detailed demographic and clinical data were recorded, and patients voluntarily joined a clinical follow-up program, with assessments preoperatively, on day one post-surgery, after one week, at 12 weeks, and after 1 year. Patients with low back pain who are diagnosed with PLID do not respond to conservative treatment or progressive neurological deficits. Patients with disc prolapse other than lumber region, malignancy, tuberculosis, and patients with severe co-morbidity and unfit for surgery, Pain and functional outcomes were measured using VAS scores and Modified Macnab criteria.

Result:

The study evaluated surgery outcomes for lumbar intervertebral disc prolapse (PLID) among 112 participants. Most participants were aged 31-40 (46.43%) and 21-30 (35.71%). Females comprised 61.61% and 20% of cases of Cauda equina syndrome. PLID primarily affected the left side (58.04%) and commonly occurred at L4-L5 (56.25%) and L5-S1 (36.61%). Pre-surgery, the mean VAS score was 7.4, dropping to 2.8 at 12 weeks post-surgery.

Conclusion:

The study found that PLID surgery at a district-level private hospital in Bangladesh resulted in significant pain reduction and excellent outcomes for most patients. Among 112 participants, mean VAS scores dropped from 7.4 to 2.8 post-surgery, with 75.89% achieving excellent results. Complications were minimal and well-managed.