Sprolapsed Lumbar Intervertebral Disc

Abstract

Absence of local literature on prolapse of the lumbar intervertebral disc prompted a review of the literature in relation to aetiological factors, current methods of investigations and some aspects of management of the condition. Disc prolapse is shown to be an end result of pathological changes secondary to anatomical, mechanical and biochemical changes in the intervertebral disc. Some of the methods of investigations cdvocated (e.g. discography, venography and C.T. Scan) are not going to be available in centres in developing countries for some while. Such centres will have to rely heavily on clinical assessment and available radiographic facilities, mainly plain x-rays and myelography. On management, surgery is still the ultimate therapy for prolapsed disc, but some patients may benefit from conservative management. Some aspects of conservative and surgical management are discussed. A retrospective study of cases of prolapsed lumbar intervertebral disc seen at the Kenyatta National Hospital over a 6 year period (1978-1984) was also done. '! - 2- It shows that lumbar intervertebral disc prolapse formed less than l%of the combined Orthopaedic and Neurosurgical cases. However the prolonged morbidity and its prevalance in the most productive age group (3rd - 4th decade) makes it a serious surgical problem. The study also shows that results of clinical examination, myelography and surgical exploration agree quite well, so that patients can be managed adequately even in the absence of sophisticated diagnostic methods. A look at the overall results of surgery indicate that (a) 69.7% of the patients benefited from surgery (b) Age and sex didn't influence the outcome of surgery, (c) Patients with a long history of symptoms pre-operatiyoly tended to have rather unsatisfactory surgical results.