{'fraction_non_alphanumeric': 0.027271401487530992, 'fraction_numerical': 0.013271109814787808, 'mean_word_length': 4.891752577319588, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Outcome of Surgical Management in Lumber Disc Prolapse:

Professor and Head, Department of Orthopedics and Spine Surgery,Addin womens medical college hospital, Dhaka, Bangladesh Professor and Head, Department of Orthopedics, Dhaka Medical College Hospital, Dhaka, Bangladesh Junior consultant, DGHS, Mohakhali, Deputation in BSMMU, Dhaka, Bangladesh Assistant professor, Department of Orthopedics, Holy Family Red Cresent Medical College Hospital, Dhaka, Bangladesh Assistant Professor, Department of Neurosurgery, Mymensingh Medical College, Dhaka, Bangladesh Medical officer, Department of Orthopedics and Spine Surgery, Addin Medical College Hospital, Dhaka, Bangladesh Medical officer, Department of Orthopedics and Spine Surgery, National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh

Peroperatively seen that 62.5% of the patients had posterolateral disc prolapse and 37.5% patients had central disc prolapse. There were only 10

Introduction
A disc herniation is the term given to any uneven outpouching or bulging of the posterior region (back region) of the intervertebral disc as seen on MRI. The bigger the lumbar/sacral disc herniation, the more likely it is to cause back and/or leg pain--the later of which is called sciatica [1]. Though low back pain and sciatica had affected the human race since time immemorial, until the first quarter of previous century, little knowledge had been acquired about the ways in which the intervertebral disc might cause compression on intra-spinal neural structures. Disc prolapse occurs in the working age adult population as they are the ones most likely to be exposed to trauma due to mechanical stress and strain. The most intervertebral disc is usually seen in fit adults between the ages of 20 and 45, but they can also occur below the age of 20 years and elderly. Males suffer more from interverebral disc prolapse than females.
Almost in 80% of cases, the protrusion is traumatic in origin and there is either a history of sudden severe strain due to heavy weight lifting or patients occupation is one in which flexion strain must be resisted, such as packer, fireman, porter, etc [3]. In

20% of cases the condition is degenerative in origin.
There is also a history of minor trauma. The precipitating factor, therefore, is mainly injury immediately or shortly before the onset of a symptom. Since the mechanism demands the combination of stress and mobility, the disc herniations commonly occur at a site where a relatively rigid segment of the spine join a flexible segment, which are subjected to greater stress and mobility. Hence, in the lumbar region, the L4-L5 and L5-S1 discs are most often affected. The standard procedure for disc removal was total laminectomy followed by a transdural approach to the disc. In 1939, Semmes presented a new procedure to remove the ruptured intervertebral disc that included subtotal laminectomy and retraction of the dural sac to expose and remove the ruptured disc with the patient under local anaesthesia [4]. This procedure is now the classic approach for removal of the intervertebral disc. Finally through the anatomic dissections and clinical observations, spinal ageing and the development of pathologic process associated with or complication the process of ageing have evolved as a primary theory in disc disease [5]. To evaluate the surgical outcome in the treatment of Lumber Disc Prolapse (LDP).

Materials and Methods
The prospective interventional study (Quasi exper-

Discussion
Low back pain commonly afflicts the adult population all over the world. It is of prime importance that the cause of low back pain is diagnosed in its early stage since not all cases are innocent [6]. The syndrome where the diagnosis is not in doubt is when root pain extends below the knee (radiculopathy) [7]. The commonest cause of radicular pain is lumbar disc prolapse. Prior to embarking on surgery for a lumbar disc prolapse it should be recalled that the long-term natural history for such a patient is likely to be good and that many radiologically proven discs may become or remain asymptomatic [8,9,10]. Moreover, the outcome of surgical therapy for lumbar disc prolapse was compared to conservative therapy, at six months there was no statistical difference between the two groups [11]. By seven years follow up the surgically treated group had faired better, only in that they had had less episodes of low back pain and had lost less time from work. In a similar study, it was found that at one year the surgical group had faired much better with 92% good results as compared with 60% in the non-surgical group [12]. However, at both four and ten year follow-up there was again no statistical difference between the two groups. It does seem, therefore, that many lumbar disc problems ameliorate by themselves eventually and that the role of surgery may serve only to hasten that final recovery.
Although there is no such comparative study in our country, it can be safely assumed that with the improvement of imaging and surgical techniques, the diagnosis and treatment of lumbar disc prolapses around the world has become more uniform.

Journal of Spine Research and Surgery 26
reported narrow disc space in 49% of patients at L5/S 1 level with positive operative findings of prolapsed disc at that level [13]. In 35% of cases there was narrow disc space at L4/5 level in X-ray but prolapse was found in only 14% of cases. Nabi et al (1982) observed narrow disc space 38.57% in their study [14]. In the present series more than one fourth patients were reported [13]. Brown  prospective studies showed good results range from 46% to 97%. Several points considered in the analysis of the results of lumbar disc surgery [16].
Patient selection appear to be extremely important.
Regarding the subjective assessment of current study patients it was observed that most (75.9%) of the patients had excellent functional outcome, 13.8% good, 6.9% fair and 3.4% had poor functional outcome according to modified Macnab criteria.

Limitations of the study
This was a cross-sectional single centered observatory study with a small sample size of sample. So, the findings of this study may not reflect the exact scenario of the whole nation.

Conclusion and Recommendations
From this study it reveals that management of prolapsed lumbar intervertebral disc by laminotomy and discectomy is an effective method of treatment and it reduces the complications and increase the chances of successful outcome. This study was done on 29 patients, follow up period was 6-12 months.
So, further study with larger sample size, longer follow up period required to delineate the outcome.

Funding
No funding sources.

Conflict of Interest
None declared.

Ethical Approval
The study was approved by the Institutional Ethics Committee.