Prospective Cohort Study for Discectomy for Herniated Lumbar Disc in Resource Limited Hospital in Rural and Urban City : Loupe Vs Microscope

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Volume 4 | Issue 1 | April 2023 – September 2023 | page: 14-19 | Ankitkumar A. Desai, Siddharth Patel, Kamlesh Jain, Keyur Buddhdev, Shubhdeepsingh Chugh

DOI: https://doi.org/10.13107/bbj.20232.v04i01.054

Authors: Ankitkumar A. Desai [1], Siddharth Patel [1], Kamlesh Jain [1], Keyur Buddhdev [1], Shubhdeepsingh Chugh [1]

[1] Department of Orthopaedics, Haria L.G. Rotary Hospital, Vapi, Gujarat, India.

Address of Correspondence

Dr. Ankitkumar Arunbhai Desai,
Consultant Spine Surgeon, Department of Orthopaedics, Haria L.G. Rotary Hospital, Vapi, Gujarat, India.
E-mail: dr.ankitdesai85@gmail.com

Abstract

Introduction: In resource limited Hospital in rural and urban city where microscopes are not readily available, I hypothesize that if properly used, good magnifying loupes could offer comparable results to the microscope in relieving rediculpathy which is the primary goal of discectomy.
Material and Methods: Prospective cohort study was conducted on 49 single level lumbar disc prolapsed patients with ridiculer leg pain between January 2017 and March 2021. The microscope was used in 15 patients (29.9%) and loupe in 34 cases (70.1%). Pre-operative assessment clinical examination with spine assessment. Surgical indications included failure of at least 6 weeks medical , physio treatment, pain or progressive neurological deficits. Micro lumbar discectomy was done in all patients. Per-and post operative parameters recorded included: length of the incision, operative time, blood loss, the presence of a wound drain, length of hospital stay, leg and back pain before discharge and in follow up visits and complications. visual analogue scale (VAS) used as a tool.
Results: The demographic, clinical characteristic , radiological characteristics and surgical technique were similar and comparable (p>0.05). The mean length of the incision was 2.5 cm for the microscope group and 3 to 3.5 cm for the loupes group (P value =0.0007).There wasn’t any statistically significant difference in both groups as regard the blood loss (p=1), complication rate and length of hospital stay (p=0.21). There wasn’t any statistically significant difference in VAS score for leg pain (p=0.32) and low back pain (p=0.46). Radicular pain recurred in equal proportion in both groups (p=0.17). 13 (86.2%) in the microscope and 32 (92.6%) in the loupe group had a 3 months post-operative VAS of zero (p=0.32).
Conclusion: Operative microscope and loupes are both justifiable alternative device in lumbar micro discectomy since both have similar and comparable outcome. In rural n urban city hospitals with less resources & less access to microscopes and other minimally invasive equipment such as the endoscope, MLD system or tubular with proven safety and effectiveness over macro disectomy , loupes are safe and effective tools for in lumbar discectomy. Operating Microscopes is more surgeon friendly as it’s gives good viewing angle without or less Work-related Musculoskeletal Disorders (WMSD).
Keywords: Microdiscectomy, Loupe, Microscope, Work-related Musculoskeletal Disorders (WMSD) Rapid Upper Limb Assessment (RULA).

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How to Cite this Article: Desai AA, Patel S, Jain K, Buddhdev K, Chugh S Prospective | Cohort Study for Discectomy for Herniated Lumbar Disc in Resource Limited Hopital in Rural and Urban City : Loupe Vs Microscope | Back Bone: The Spine Journal | April 2023-September 2023; 4(1): 14-19 | https://doi.org/10.13107/bbj.2023.v04i01.054

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