Fenestrated discectomy, is it still the gold standard in resource poor setting, an experience of overall outcome in a single orthopaedic unit.

Abstract

Objective: Lower back pain with radiculopathy poorly responding to non-operative management is common . Microdiscectomy(MD) is currently the gold standard in ideal settings. Our objective was to evaluate the overall outcome of standard open Fenestrated Discectomy(FD) in relation to published data on microdiscectomy.

Method: This is a prospective study of 24 consecutive patients, who underwent FD over six months in relation to the operative time, complications, cost and patient satisfaction eight weeks post procedure.

Results: Mean age was 42 years (range 21-60yrs) and 75% were males. The most commonly affected disc was L4-5, in 62.5%.  All patients had their activities of daily living affected. Night pain disturbing the sleep in 87.5% and neurogenic claudication in 62.5%.  Nerve root compression was there in 79.2% while 20.8% had cord compression on MRI. Only 4.2% had Cauda Equina syndrome. Mean duration of the surgery was 40 minutes and mean duration of post-op stay was 4.2 days as compared to 70 minutes and 2.5 days in MD. Seventy one percent had uneventful recovery.  Acute retention of urine in 21% and surgical site infections in 8.3% were the commonest complications. Mean cost of the procedure(FD) was 25300LKR as compared to 40000LKR for MD . Night pain resolved in 91.7% in the first post operative day and returned to normal function with overall satisfaction of 95.8% within eight weeks as compared to 85-90% in MD

Conclusions: FD is a versatile and cost effective procedure with comparable outcome to MD in resource poor settings.