Pre_and postoperative evaluation of patients with lumbosacral disc herniation (L4L5, L5S1)by neurophysiological, Radiological and clinical assessment.

Objective: Pre and postoperative evaluation of patients with lumbosacral disc herniation by neurophysiological, radiological and clinical assessment.Patient and method: This prospective and retrospective cohort study was conducted at Saad Al-Witry neuroscience teaching hospital in Baghdad in the period extended from January 2017 to October 2023. The study included a total number of 1000 cases gathered from a neurosurgical team specialized in spine cases handling. The selection of cases was based on clinical and neurological examination. In whom medical therapy failed to control patients' symptoms.The patients were observed during their initial visit to the clinic, the day of the procedure, 2 weeks postoperatively then 5 years following intervention to check response {pain, motor, sensory, autonomic, electrophysiology (EMG/ NCS)}.Results:Within 1 week postoperatively 82.5% patients became pain free, while the remaining 9% improved within less than a month and remained improved after more than 1 month. However, 62.5% of those patients who presented with saddle paresthesia showed improvement within 1 week postoperatively, while the remainder improved within 1 month. But none of the patients who presented with L5 radiculopathy showed improvement within 12 weeks of surgery, but 23.1% improved within 12-24 weeks, 22.5% within 48 weeks and remained within 5 yearsWe observed that most cases had improvement in foot drop within one week postoperatively 67.5%.Regarding urinary incontinence, the duration of symptoms before surgery had a significant correlation with improvement.Conclusion: Single or multiple level discectomy for herniated lumbar discs is an effective surgical method to decrease pain and improve quality of life of patients suffering from pain non responding to conservative management or presenting with sensory or motor deficit.Preoperative and Postoperative electrodiagnostic studies did not show significant differences and thus we concluded that electrodiagnostic studies don’t prove reasonable adjuncts for postoperative follow-up.