Long-Term Clinical Outcomes in Patients Undergoing Microscopic Lumbar Discectomy by Fenestration- An Analysis of 1000 Cases

Abstract

Background: The first reports of lumbar discectomy for PLID date back to the 1920s. In the USA, this is the most often performed surgical spine operation. Although there is a wide variety of published data showing generally satisfactory surgical outcomes, the success rate for lumbar discectomy falls between 49% and 90%. Follow-up studies investigating the clinical results of lumbar discectomy by fenestration are uncommon in our nation. As neurosurgeons, we refer to it as the ABC of neurosurgery. Although some refer to it as the "bread and butter" of neurosurgeries, this procedure is crucial for neurosurgeons. Objective: The aim of the study was to investigate the long-term outcome of microscopic fenestration & discectomy and relevant factors associated with clinical outcome. Methods: The retrospective study was conducted in the department of neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, from March 2018 to February 2024. A total of 1000 patients (Min and Max follow-up was done by 6 months and 72 months respectively) were included in the analysis. Patients who underwent Microscopic lumbar discectomy by fenestration were evaluated retrospectively, using the Modified Oswestry disability index (ODI; 0-20 minimal, 21-40 moderate, > 41 severe disability) and the Stauffer-Coventry criteria (excellent', 'good', 'fair', 'poor') to measure clinical outcomes. Results: This observational cross-sectional study was conducted in the Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, A total of 1000 apparent patients were included in the study. Most of the 360(36.0%) patients were within the age group of 35-44 years. The mean±SD age of the patients was 38.6±1.3 years. Most of the patients 720(72.00%) were male and 280(28.00%) patients were female. The mean onset of preoperative pain was 9.6±3.3 months. Follow-up period was 39.6±3.2 months. At final follow-up, patients were rated as 'excellent' 777(77.7%), 'good' 173(17.3%), 'fair' 30(3.0%) and 'poor' 10(1.0%) using the Stauffer-Coventry criteria. Heavy manual work, heavy weight, uncontrolled diabetic and elderly were significantly associated with unsatisfactory outcomes. Conclusion: The long-term outcome of Microscopic lumbar discectomy by fenestration was satisfactory in the majority of patients. Heavy manual work, Heavy weight, elderly were negative predictors of a good clinical outcome.