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International Journal of Orthopaedics Sciences 2021; 7(2): 14-19
E-ISSN: 2395-1958
P-ISSN: 2706-6630
IJOS 2021; 7(2): 14-19
© 2021 IJOS
www.orthopaper.com
Received: 19-11-2020
Accepted: 02-02-2021
Dr. Ramavtar Saini
Professor & Unit Head,
Department of Orthopaedics,
Geetanjali Medical College and
Hospital, Udaipur, Rajasthan,
India
Dr. Anshu Sharma
Assistant Professor, Department
of Orthopaedics, Geetanjali
Medical College and Hospital,
Udaipur, Rajasthan, India
Dr. Kshitij Agrawal
3
rd
year Resident, Department of
Orthopaedics, Geetanjali Medical
College and Hospital,
Udaipur, Rajasthan, India
Dr. Utkarsh Patel
3
rd
year Resident, Department of
Orthopaedics, Geetanjali Medical
College and Hospital,
Udaipur, Rajasthan, India
Dr. Abhishek Dholakia
3
rd
year Resident, Department of
Orthopaedics, Geetanjali Medical
College and Hospital,
Udaipur, Rajasthan, India
Dr. Dharan Shah
3
rd
year Resident, Department of
Orthopaedics, Geetanjali Medical
College and Hospital,
Udaipur, Rajasthan, India
Corresponding Author:
Dr. Kshitij Agrawal
3
rd
year Resident, Department of
Orthopaedics, Geetanjali medical
College and Hospital,
Udaipur, Rajasthan, India
Comparative evaluation of functional outcome of
discectomy and posterior lumbar interbody fusion for
treatment of prolapse intervertebral disc
Dr. Ramavtar Saini, Dr. Anshu Sharma, Dr. Kshitij Agrawal, Dr. Utkarsh
Patel, Dr. Abhishek Dholakia and Dr. Dharan Shah
DOI: https://doi.org/10.22271/ortho.2021.v7.i2a.2607
Abstract
Background: Lumbar disc herniation is the most common cause of low back pain and significant
disability with economic impact too. Management of disc herniation is challenging, often confusing
when surgical treatment is considered, because of frequent failures after surgery in many patients to
relieve symptoms. In the current study, we aimed to compare the functional outcomes of treating PIVD
with discectomy alone and discectomy associated with posterior lumbar interbody fusion (PLIF).
Materials and Methods: This study is randomised control study was conducted over 36 patients
diagnosed with PIVD and operated for Discectomy (18 patients) or PLIF (18 patients) in Orthopaedic
department, Geetanjali Medical College, Udaipur, Rajasthan between January 2019 to June 2020 and
randomly allotted in two groups.To evaluate Functional outcomes using Japanese orthopedic score (JOA)
and kirkaldy-willis criteria in every follow up at 2 week, 6 week, 3 month and 6 month.
Results: Calculating the functional outcome by both the criteria in all follow ups, we concluded that in
early follow up that is of second post op week, discectomy shows satisfactory outcome then that of PLIF
group. In 6 month last follow up, PLIF group show satisfactory outcome then that of Discectomy patients
groups and p value was 0.0042 which was significant. Out of 36 patients, one patient had dura rupture
intraoperatively which was repaired simultaneously and one patient had surgical site infection which
resolved later on, both patients were in discectomy group.
Conclusions: Although both discectomy alone and discectomy with PLIF were associated with favorable
mid-term results in treating patients with PIVD, however, we recommend using discectomy with PLIF
for lower radicular pain for better long term results..
Keywords: PIVD, PLIF, discectomy, Japanese orthopaedic score
Introduction
Lumbar disc herniation is one of the common cause of lower back pain
[1, 2]
. Management of
disc herniation can be challenging. Non operative treatment gives good results in the majority
of the cases. Operative treatments have better results mostly in short term pain relief and can
provide relief if neural decompression is done. Early surgery does appear to affect the rate of
Neurological recovery, although objective improvement in motor and sensory deficits does not
appear to correlate with symptomatic relief and overall success rate
[3]
. With this evidence, it
has been recognized that discectomy can give excellent early results in majority of patients
with symptomatic relief with a satisfactory rate of over 95%
[4, 5]
. However, the long-term
results of discectomy would become less concrete, with satisfactory rates from 40% to 80%
[6]
.
Posterior Lumbar Interbody Fusion (PLIF) is the used to describe the technique of surgical
fusion of two (or more) lumbar spine bones together, along the sides of the bone, which uses
placement of cage, spacer or structural graft in between the vertebral bodies, which is done
after discectomy and bony end plates preparation and ultimately it fuses together in period of
time.
The credit for initially developing the techniques of the PLIF surgery, as it is performed today,
goes to Cloward
[7]
, who emphasized the importance of wide exposure of the spinal canal to
minimize nerve root injuries, the use of structural graft to prevent Intervertebral collapse and
the complete removal of nuclear material from the disc space and replacement with bone to