A COMPARATIVE STUDY OF TWO LEVELS DISCECTOMY WITH OR WITHOUT POSTERIOR INTERBODY FUSION IN A TERTIARY CARE HOSPITAL

COMPARATIVE STUDY OF TWO LEVELS DISCECTOMY WITH OR WITHOUT POSTERIOR INTERBODY FUSION IN A TERTIARY CARE HOSPITAL

Abstract

BACKGROUND:

                          Lumbar disc herniation is considered as major cause of chronic backache & radiculopathy. Recurrent disc herniation and instability are common with multilevel discectomy while degenerative problems of adjacent segment are more common with interbody fusion.

OBJECTIVES:

                      To compare the functional outcomes & complications of two levels disc excision with or without posterior lumbar interbody fusion.

METHODOLOGY:

This prospective randomized controlled study was carried out at Department of Orthopaedic Surgery Jinnah Hospital, Lahore from June 2024 to November, 2025. A total number of 50 patients with two levels intervertebral disc prolapse , divided into two equal groups A & B with 25 patients in each group. In group A, we performed discectomy in group A while in group B, discectomy with posterior Lumbar interbody fusion was done. The functional outcomes were evaluated by using Owestry Disability Index(ODI)& Visual Analogue Score(VAS) at 06 weeks, 03 months, 06 months & one year after the surgery.

RESULTS:

A significant pain reduction at 6^th, 12 weeks and 6^th months in both groups but Group A typically shows faster pain relief in the immediate postoperative phase ( p< 0.05), while Group B shows better long-term stability for back pain. VAS Score was 7.4- 7.6 as base line  in both groups. At the end of one year, it was 2.0 to 3.0 in group A while 2.8 to 3.5 in group B. There was no significant difference in terms of Owestry Disability Index (ODI) at 6 and 12^th week (p> 0.05) but had a significant difference at 6^th months (p< 0.05).

CONCLUSION:

For L4-5 and L5-S1 herniation, discectomy (Group A) alone offers less operative duration and better pain relief after followup of one year but the recurrence rate of disc herniation is high  I.e;22%in our study. Posterior lumbar inter body fusion in group B is more technically demanding and provides a definitive solution for recurrence, making it an alternative option for patients with risk of instability

KEY WORDS: Lumbar Spine, Disc Herniation, Posterior lumbar interbody fusion, Discectomy