Efficacy of Discectomy by Fenestration Technique in Lumbar Radicular Pain

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.  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).  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