JSM Neurosurgery and Spine

Lumbar Disc Erniation L4-L5; L5-S1: An Original Study

Research Article | Open Access | Volume 9 | Issue 2

  • 1. Department Orthopaedic and Trauma Surgery
+ Show More - Show Less
Corresponding Authors
Saccomanni Bernardino, Department Orthopaedic and Trauma Surgery, Viale Regina Margherita, 70022, Altamura (Bari), Italy, Tel: 3208007854

Objectives or purpose or study design: To evaluate the Functional & Neurological outcome of Lumbar Microdiscectomy at L4/5 and L5/S1.

Background: Lumbar disc herniation (LDH) is the most common specific cause for low back pain (LBP). It is a degenerative process causing annular tear with extrusion of the nucleus pulposus through posterior midline or posterolateral aspect of the disc leading to compression of the thecal sac and nerve roots with radicular symptoms. Surgery is reserved for only those who are refractory for a fair trial of nonsurgical management for at least 6 weeks, need of decompression for conus and cauda equina compression, needing immediate attention. There have been various modalities of treatment that have evolved over the years. Micro-lumbar discectomy is one of the latest additions of surgical management modality.

Materials & Method: Retrospectively we reviewed 30 cases from january 2010 to december 2012 in hospital in ALTAMURA ITALY. All the patients had back pain & some neurological deficit with positive MRI findings, underwent lumbar microdiscectomy al L4/5 & L5/S1. Functional improvement was assessed by the ODI Score & categorized into excellent, good, fair & poor, Neurological improvement was assessed by the Nurick Score improvement of pain control by VAS score & overall functional assessment by modified Odom’s score.

Results: Total number of patients was 30. Average age was 36 years (range 22-50). Average follow-up period was 9 months. Pre-operative ODI score was 54.6±12.8 & Post-operative score was improved to 10.2±3.3. In our series we have no chair bound or bedridden patients after surgery. The Pre-operative & Postoperative nurick score was 2.9 & 0.8 respectively. There was no difference in neurological outcomes comparing patients older and younger than 40 years. There was significant improvement in Pre-operative & Post- operative VAS score for leg pain was 6.90 ± 1.9 & 2.0 ± 0.8 respectively & for low back pain was 5.8±1.2 & 2.2±0.8 respectively.

Conclusion: Lumbar Microdiscectomy is a safe & effective method to treat the patients with lumbar disc prolapse with shorter hospital stay & better prognosis with minimum & considerable complications.


Lumbar Disc; Original study


Bernardino S (2022) Lumbar Disc Erniation L4-L5; L5-S1: An Original Study. JSM Neurosurg Spine 9(2): 1109


Backache resulting from Lumbago-sciatica is one of the oldest diseases of history. For decades lumbar disc disease is a commonly encountered spine problem for the spine surgeons. Disc herniation causing radicular pain with or without neuro-deficit and those do not respond to conservative management for at least 6 weeks, having their activities of daily living affected are managed surgically (Figure 1).

Figure 1 Pathology of lumbar disc.

Figure 1: Pathology of lumbar disc.

Discectomy for symptomatic lumbar disc herniation is performed commonly performed surgical spinal procedure [1]. The first lumbar discectomy was done by a laminectomy and transdural approach was performed by Mixter and Barr in 1934. Semmes first described the hemi-laminectomy approach with retraction of the dura to decompress the neural elements. Discectomy by laminectomy was the common approach for prolapsed disc for a very long time. However, this involved removal of a large amount of normal bone, ligamentum flava, muscle tissue and sometimes facet joints which resulted in iatrogenic instabilities to the spine and failed back syndromes. Hence, conventional laminectomy and discectomy has been replaced by soft tissue techniques.

With the devolopment of better retractor systems, illumination and magnification, discectomies are performed by a more conservative route of interlaminar approaches. Love described his interlaminar fenestration technique as early as 1939. Surgeons have modified Love’s technique to make it minimally invasive [2].

Conventional fenestration technique used paraspinal muscular elevation bilaterally, and larger incisions and retractor systems.

Interlaminar approach was used to enter the epidural space, with aggressive discectomy.

Patient selection and/or preoperative evaluation of the patients should be carefully done to increase patient’s outcome after the microdiscectomy. In young and athletic patients, we prefer microdiscectomy, because strong paravertebral muscles will share the loading with spinal column.

In minimally invasive techniques, paraspinal muscular elevation is done for only 2 to 3 cm using specialised retractor systems.

Caspar in 1977 and Williams in 1978 described microlumbar discectomy technique [3,4]. Due to the postulated advantages of reduced tissue invasiveness, limited blood loss, a shorter duration of surgery, and a faster postoperative recovery, minimally invasive microdiscectomy is very popular now a days. Adequate illumination and magnification of the opetative field are achieved by the use of microscopes, operating loupes and head lamps or endoscopes. Minimally invasive techniques have the overall advantage of less tissue scarring and better visualization of the dura, roots and disc spaces and hence are expected to have better postoperative outcomes [5]. The added advantage of of this procedure is minimum tissue damage & less chance of fibrosis.

Perineural and epidural fibrosis was reported in the subsequent study. Epidural fibrosis/ perineural fibrosis is a nightmare to any managing physician and a major bane for the affected patient.

There have been various modalities of treatment for this disease condition that have evolved over the years. The objective of our study is to analyze safety, efficacy, and complications following Micro-lumbar discectomy (Figures 2,3).

Figure 2 Sagittal MRI of L/S Spine

Figure 2: Sagittal MRI of L/S Spine

Figure 3 Axial MRI of L/S Spine with pilot film.

Figure 3: Axial MRI of L/S Spine with pilot film.


Retrospectively we reviewed 30 cases from 2010 to 2012 of Lumbar disc herniation. All patients presented with the various symptoms and signs with the positive magnetic resonance imaging (MRI) and underwent decompression by microlumbar discectomy. Functional improvement was assessed by the ODI Score, Neurological improvement was assessed by the Nurick Score, improvement of pain control by VAS score & overall functional assessment done by modified Odom’s score. IBMSPSS V26 software was used for statistical analysis.


Inclusion criteria

Patients with low back pain who are diagnosed as PLID at L4/5 &/or L5/S1 & not responding to conservative treatment or progressive neurological deficit.

Exclusion criteria

Patients with lumbar disc prolapse other than L4/5 &/or L5/ S1, malignancy, tuberculosis & patients with severe co-morbidity for which he/she is unfit for surgery.

Operative Procedure

The patient should have prone position. Careful inspection should Functional & Neurological outcome of Lumbar Microdiscectomy at L4/5 and L5/S1 be done to the eyes, ulnar nerves, and genitalia for the males, and breast for the females to ensure that excessive pressure does not exist. Abdominal viscera and vessels should be checked to hang free. The surgical area is propped with an antiseptic solution and covered with sterile clothes. The discectomy level should be identified with C-arm before the operation and incision line is marked.

The length of the incision line changes between 1.5 -2 cm, the lower point of incision should be the upper point of lower spinal process. While performing incision, subcutaneous tissue should not be destroyed to avoid fat tissue necroses. Fascia should be opened just lateral border of spinous process to keep supraspinous ligament intact.

After dissection of the muscle tissue on the spinous process and lamina, it should be cared to the two important points. First of them is to save the capsular ligament and second is to leave intact the interspinous ligament; therefore retractor should not be forced against interspinous ligament. The next step is to save ligamentum flavum. In L5-S1 level, the ligamentum flavum is opened from the medial side to lateral as a flap like C and fixed with a spinal needle to the lateral wall. Under the microscope magnification, epidural fat tissue retracted medially with nerve root. This procedure should be performed gently, because there is a very thin layer to keep the fat tissue. If this layer is opened, the dispersed fat tissue can prevent to see the nerve root. The thin layer should be opened just under the nerve root. Some epidural veins can be seen and coagulated with bipolar. After these procedures, disc annulus can easily be found under the nerve root and discectomy is performed. After the discectomy, ligamentum flavum is placed on the epidural fat tissue. The fascia is sutured and skin is closed with subcutaneous intradermal sutures (Figure 4).

Figure 4 Percutaneous identification of L5/S1 space by guide pin with  C-Arm image.

Figure 4: Percutaneous identification of L5/S1 space by guide pin with C-Arm image.


The retrospective analytical study includes 30 patients who fulfilled the inclusion criteria, were operated by microlumbar discectomy for PLID at L4/5 &/or L5/S1. All patients were followed up from 6 months to 1 year (average 9 months) post-operatively (Tables 1-6).

Table 1: Demographic Distribution of Patients (n=30).

Hospital Stay
Surgery Time
Blood Loss
Follow-up (mouths) L4/5 L5/S1
17/13 40.3 ± 10.1 3.60 ± 1.26 32.80 ± 10.47 28 ± 12.67 15 ± 9 17 13

Table 2: Pre-operative and post-operative comparison of pain.

After 12 months (n=30), According to VAS score
Score (VAS) Pre Operative (Mean ± SD) Final Follow-up (Mean ± SD) p value
Back Pain 6.90 ± 1.9 1.8 ± 0.8 <0.001
Leg Pain 5.8±1.2 2.2±0.8 <0.001

Table 3: Pre-operative and post-operative Nurick Score (n=30).


Pre Operative

Post Operative




Table 4: Pre-operative and post-operative ODI Score.


Pre Operative

Post Operative


54.6 ± 12.8

10.0 2± 3.3

Table 5: Distribution of patients according to post-operative.

Clinical Outcome (n=30)

According to Modified Odom’s Criteria (Odom et al, 1958)


Frequency (n) Percentage





Percutaneous identification of L5/S1 space by guide pin




With C-Arm image







Table 6: Distribution of patients according to post-operative.


Complications No. Of patients

Wound dehiscence


Radicular pain




Wound Infection




Dural leakage





Patients treated by micro lumbar discectomy were followed up for the period of 12 months. Overall clinical outcome categorized as excellent, good, fair, and poor according to modified Odom’s criteria. For statistical analysis good and excellent were grouped as satisfactory and fair and poor as unsatisfactory.

n this study, age range of the patients were 27 – 55 years, mean age was 40.3 ±10.1 years and the male to female ratio was 1.3:1 which are comparable to the study of Fabres A et al, who found mean age 43.1 ± 13.6 [6].

ll 30 (100%) patients had low back pain & radicular pain, motor deficit in 6 (20%) patients, sensory deficit in 5 (16.67%) patients, foot drop in 1(3%) patient, bowel & bladder involvement in 2 (6.6%). This is also comparable to study of Raghu et al. All were improved significantly (P<.001) in postoperative group [7].

Regarding the leg pain control according to VAS was 6.90± 1.90 preoperatively and significantly decreased to 1.6 ± 0.8 at the last follow-up (P< 0.001). This corresponds to the study of Jaiswal et al. In our series the, pre & post-operative Nurick score was 2.9 & 0.8 which was satisfactory for the patients [8].

The mean ODI score was 54.6±12.8 & 10.2±3.3 respectively which is compitable to the study of Jaiswal et al. The differences in the ODI scores were statistically significant between the pre and postoperative follow-ups (p<0.001). ODI scores below 40% were graded as good outcomes (success), whereas higher scores were considered partial or total failures.

Post-operative superficial wound infection was in 2 (6.7%) Wound infection was managed conservatively by antibiotics according to culture and sensitivity report, improvement of nutritional status, removal of stitch, regular dressing & secondary wound closure. The average peri-operative blood loss was 28±12.67 ml. Per-operative dural leakage occurred in 1 patient,

who was managed by dural repair & placement of a drain tube with early removal of drain. The average post-operative hospital stay was 2-4 days. In our study, 21 (70%) patients got satisfactory results and 7 (23%) patients got Good result, in 2 (7%) case had fair outcome according to the Modified Odom’s Criteria. In our series, there was no radio-logical progression after surgery [9- 15].


Lumbar Microdiscectomy is a safe & effective method to treat the patients with lumbar disc prolapse with shorter hospital stay & better prognosis with minimum & considerable complications.


1. Majeed SA, Vikraman CS, Mathew V, Anish TS. Comparison of outcomes between conventional lumbar fenestration discectomy and minimally invasive lumbar discectomy: an observational study with a minimum 2-year follow-up. J Orthop Surg Res. 2013; 8: 34.

2. Ali Fahir Ozer, Murat Cosar. Lumbar Degenerative Disc Disease and Dynamic Stabilization. Total Disc Replacement. 1939; 1-14.

3. Caspar W. A new surgical procedure for lumbar disc herniation causing less tissue damage through a microsurgical approach. InLumbar disc adult hydrocephalus. 1977; 74-80.

4. Williams RW. Microlumbar discectomy: a conservative surgical approach to the virgin herniated lumbar disc. Spine. 1978; 3: 175-82.

5. Aichmair A, Du JY, Shue J, Evangelisti G, Sama AA, Alexander P Hughes, et al. Microdiscectomy for the treatment of lumbar disc herniation: an evaluation of reoperations and long-term outcomes. Evid Based Spine Care J. 2014; 5: 077-86.

6. Fabres A, Escudero N, Schiappacasse R, Cerda J, Salazar C, Silva MT, et al. Outpatient Lumbar Microdiscectomy: Safe, High Patient Satisfaction and Lower Cost. Ambulatory Surgery. 2021; 27.

7. Raghu V, Ranade D, Patil A, Gotecha S, Punia P, Ashish Chugh, et al. A comparative study of conventional microlumbar discectomy and endoscopic lumbar discectomies. ISJ. 2021; 8: 3024-30.

8. Jaiswal A, Kumar S, Reddy S, Jaiswal P. Feasibility and safety of outpatient lumbar microscopic discectomy in a developing country. Asian Spine J. 2019; 13: 721-729.

9. Hoppenfeld S, DeBoer P, Buckley R. Surgical exposures in orthopaedics: the anatomic approach. Lippincott Williams & Wilkins 2012 Mar 28.

10.Love JG, Camp JD. Root pain resulting from intraspinal protrusion of intervertebral discs: diagnosis and surgical treatment. JBJS. 1937; 19: 776-804.

11. Magee A, Bhaskar IP, Ilett P, Murphy MA, Wang YY. Clinical and health economic benefits of out-patient lumbar microdiscectomies in Australia. DOAJ. 2016; 26: 15-20.

12.Bhattarai B, Sah SB. A Retrospective Observational Analysis on the Outcome of Microlumbar Discectomy among 70 Consecutive Cases in the Tertiary Care Spine Center in Nepal. NJNS. 2019; 16:34-9.

13. Asati S, Jain S, Kundnani VG. Tubular Discectomy Versus Conventional Microdiscectomy for the Treatment of Lumbar Disc Herniation: A Comparative Study. JMISST. 2020; 5: 51-6.

14. Debono B, Sabatier P, Garnault V, Hamel O, Bousquet P, Jean-Paul Lescure, et al. Outpatient lumbar microdiscectomy in France: from an economic imperative to a clinical standard—an observational study of 201 cases. World Neurosurg. 2017; 106: 891-7.

15. Azar FM, Canale ST, Beaty JH. Campbell’s Operative Orthopaedics, E-Book. Elsevier Health Sciences. 2020; 23.

Bernardino S (2022) Lumbar Disc Erniation L4-L5; L5-S1: An Original Study. JSM Neurosurg Spine 9(2): 1109

Received : 10 Nov 2022
Accepted : 10 Dec 2022
Published : 13 Dec 2022
Annals of Otolaryngology and Rhinology
ISSN : 2379-948X
Launched : 2014
JSM Schizophrenia
Launched : 2016
Journal of Nausea
Launched : 2020
JSM Internal Medicine
Launched : 2016
JSM Hepatitis
Launched : 2016
JSM Oro Facial Surgeries
ISSN : 2578-3211
Launched : 2016
Journal of Human Nutrition and Food Science
ISSN : 2333-6706
Launched : 2013
JSM Regenerative Medicine and Bioengineering
ISSN : 2379-0490
Launched : 2013
JSM Spine
ISSN : 2578-3181
Launched : 2016
Archives of Palliative Care
ISSN : 2573-1165
Launched : 2016
JSM Nutritional Disorders
ISSN : 2578-3203
Launched : 2017
Annals of Neurodegenerative Disorders
ISSN : 2476-2032
Launched : 2016
Journal of Fever
ISSN : 2641-7782
Launched : 2017
JSM Bone Marrow Research
ISSN : 2578-3351
Launched : 2016
JSM Mathematics and Statistics
ISSN : 2578-3173
Launched : 2014
Journal of Autoimmunity and Research
ISSN : 2573-1173
Launched : 2014
JSM Arthritis
ISSN : 2475-9155
Launched : 2016
JSM Head and Neck Cancer-Cases and Reviews
ISSN : 2573-1610
Launched : 2016
JSM General Surgery Cases and Images
ISSN : 2573-1564
Launched : 2016
JSM Anatomy and Physiology
ISSN : 2573-1262
Launched : 2016
JSM Dental Surgery
ISSN : 2573-1548
Launched : 2016
Annals of Emergency Surgery
ISSN : 2573-1017
Launched : 2016
Annals of Mens Health and Wellness
ISSN : 2641-7707
Launched : 2017
Journal of Preventive Medicine and Health Care
ISSN : 2576-0084
Launched : 2018
Journal of Chronic Diseases and Management
ISSN : 2573-1300
Launched : 2016
Annals of Vaccines and Immunization
ISSN : 2378-9379
Launched : 2014
JSM Heart Surgery Cases and Images
ISSN : 2578-3157
Launched : 2016
Annals of Reproductive Medicine and Treatment
ISSN : 2573-1092
Launched : 2016
JSM Brain Science
ISSN : 2573-1289
Launched : 2016
JSM Biomarkers
ISSN : 2578-3815
Launched : 2014
JSM Biology
ISSN : 2475-9392
Launched : 2016
Archives of Stem Cell and Research
ISSN : 2578-3580
Launched : 2014
Annals of Clinical and Medical Microbiology
ISSN : 2578-3629
Launched : 2014
JSM Pediatric Surgery
ISSN : 2578-3149
Launched : 2017
Journal of Memory Disorder and Rehabilitation
ISSN : 2578-319X
Launched : 2016
JSM Tropical Medicine and Research
ISSN : 2578-3165
Launched : 2016
JSM Head and Face Medicine
ISSN : 2578-3793
Launched : 2016
JSM Cardiothoracic Surgery
ISSN : 2573-1297
Launched : 2016
JSM Bone and Joint Diseases
ISSN : 2578-3351
Launched : 2017
JSM Bioavailability and Bioequivalence
ISSN : 2641-7812
Launched : 2017
JSM Atherosclerosis
ISSN : 2573-1270
Launched : 2016
Journal of Genitourinary Disorders
ISSN : 2641-7790
Launched : 2017
Journal of Fractures and Sprains
ISSN : 2578-3831
Launched : 2016
Journal of Autism and Epilepsy
ISSN : 2641-7774
Launched : 2016
Annals of Marine Biology and Research
ISSN : 2573-105X
Launched : 2014
JSM Health Education & Primary Health Care
ISSN : 2578-3777
Launched : 2016
JSM Communication Disorders
ISSN : 2578-3807
Launched : 2016
Annals of Musculoskeletal Disorders
ISSN : 2578-3599
Launched : 2016
Annals of Virology and Research
ISSN : 2573-1122
Launched : 2014
JSM Renal Medicine
ISSN : 2573-1637
Launched : 2016
Journal of Muscle Health
ISSN : 2578-3823
Launched : 2016
JSM Genetics and Genomics
ISSN : 2334-1823
Launched : 2013
JSM Anxiety and Depression
ISSN : 2475-9139
Launched : 2016
Clinical Journal of Heart Diseases
ISSN : 2641-7766
Launched : 2016
Annals of Medicinal Chemistry and Research
ISSN : 2378-9336
Launched : 2014
JSM Pain and Management
ISSN : 2578-3378
Launched : 2016
JSM Women's Health
ISSN : 2578-3696
Launched : 2016
Clinical Research in HIV or AIDS
ISSN : 2374-0094
Launched : 2013
Journal of Endocrinology, Diabetes and Obesity
ISSN : 2333-6692
Launched : 2013
Journal of Substance Abuse and Alcoholism
ISSN : 2373-9363
Launched : 2013
Journal of Liver and Clinical Research
ISSN : 2379-0830
Launched : 2014
Journal of Drug Design and Research
ISSN : 2379-089X
Launched : 2014
JSM Clinical Oncology and Research
ISSN : 2373-938X
Launched : 2013
JSM Bioinformatics, Genomics and Proteomics
ISSN : 2576-1102
Launched : 2014
JSM Chemistry
ISSN : 2334-1831
Launched : 2013
Journal of Trauma and Care
ISSN : 2573-1246
Launched : 2014
JSM Surgical Oncology and Research
ISSN : 2578-3688
Launched : 2016
Annals of Food Processing and Preservation
ISSN : 2573-1033
Launched : 2016
Journal of Radiology and Radiation Therapy
ISSN : 2333-7095
Launched : 2013
JSM Physical Medicine and Rehabilitation
ISSN : 2578-3572
Launched : 2016
Annals of Clinical Pathology
ISSN : 2373-9282
Launched : 2013
Annals of Cardiovascular Diseases
ISSN : 2641-7731
Launched : 2016
Journal of Behavior
ISSN : 2576-0076
Launched : 2016
Annals of Clinical and Experimental Metabolism
ISSN : 2572-2492
Launched : 2016
Clinical Research in Infectious Diseases
ISSN : 2379-0636
Launched : 2013
JSM Microbiology
ISSN : 2333-6455
Launched : 2013
Journal of Urology and Research
ISSN : 2379-951X
Launched : 2014
Journal of Family Medicine and Community Health
ISSN : 2379-0547
Launched : 2013
Annals of Pregnancy and Care
ISSN : 2578-336X
Launched : 2017
JSM Cell and Developmental Biology
ISSN : 2379-061X
Launched : 2013
Annals of Aquaculture and Research
ISSN : 2379-0881
Launched : 2014
Clinical Research in Pulmonology
ISSN : 2333-6625
Launched : 2013
Journal of Immunology and Clinical Research
ISSN : 2333-6714
Launched : 2013
Annals of Forensic Research and Analysis
ISSN : 2378-9476
Launched : 2014
JSM Biochemistry and Molecular Biology
ISSN : 2333-7109
Launched : 2013
Annals of Breast Cancer Research
ISSN : 2641-7685
Launched : 2016
Annals of Gerontology and Geriatric Research
ISSN : 2378-9409
Launched : 2014
Journal of Sleep Medicine and Disorders
ISSN : 2379-0822
Launched : 2014
JSM Burns and Trauma
ISSN : 2475-9406
Launched : 2016
Chemical Engineering and Process Techniques
ISSN : 2333-6633
Launched : 2013
Annals of Clinical Cytology and Pathology
ISSN : 2475-9430
Launched : 2014
JSM Allergy and Asthma
ISSN : 2573-1254
Launched : 2016
Journal of Neurological Disorders and Stroke
ISSN : 2334-2307
Launched : 2013
Annals of Sports Medicine and Research
ISSN : 2379-0571
Launched : 2014
JSM Sexual Medicine
ISSN : 2578-3718
Launched : 2016
Annals of Vascular Medicine and Research
ISSN : 2378-9344
Launched : 2014
JSM Biotechnology and Biomedical Engineering
ISSN : 2333-7117
Launched : 2013
Journal of Hematology and Transfusion
ISSN : 2333-6684
Launched : 2013
JSM Environmental Science and Ecology
ISSN : 2333-7141
Launched : 2013
Journal of Cardiology and Clinical Research
ISSN : 2333-6676
Launched : 2013
JSM Nanotechnology and Nanomedicine
ISSN : 2334-1815
Launched : 2013
Journal of Ear, Nose and Throat Disorders
ISSN : 2475-9473
Launched : 2016
JSM Ophthalmology
ISSN : 2333-6447
Launched : 2013
Journal of Pharmacology and Clinical Toxicology
ISSN : 2333-7079
Launched : 2013
Annals of Psychiatry and Mental Health
ISSN : 2374-0124
Launched : 2013
Medical Journal of Obstetrics and Gynecology
ISSN : 2333-6439
Launched : 2013
Annals of Pediatrics and Child Health
ISSN : 2373-9312
Launched : 2013
JSM Clinical Pharmaceutics
ISSN : 2379-9498
Launched : 2014
JSM Foot and Ankle
ISSN : 2475-9112
Launched : 2016
JSM Alzheimer's Disease and Related Dementia
ISSN : 2378-9565
Launched : 2014
Journal of Addiction Medicine and Therapy
ISSN : 2333-665X
Launched : 2013
Journal of Veterinary Medicine and Research
ISSN : 2378-931X
Launched : 2013
Annals of Public Health and Research
ISSN : 2378-9328
Launched : 2014
Annals of Orthopedics and Rheumatology
ISSN : 2373-9290
Launched : 2013
Journal of Clinical Nephrology and Research
ISSN : 2379-0652
Launched : 2014
Annals of Community Medicine and Practice
ISSN : 2475-9465
Launched : 2014
Annals of Biometrics and Biostatistics
ISSN : 2374-0116
Launched : 2013
JSM Clinical Case Reports
ISSN : 2373-9819
Launched : 2013
Journal of Cancer Biology and Research
ISSN : 2373-9436
Launched : 2013
Journal of Surgery and Transplantation Science
ISSN : 2379-0911
Launched : 2013
Journal of Dermatology and Clinical Research
ISSN : 2373-9371
Launched : 2013
JSM Gastroenterology and Hepatology
ISSN : 2373-9487
Launched : 2013
Annals of Nursing and Practice
ISSN : 2379-9501
Launched : 2014
JSM Dentistry
ISSN : 2333-7133
Launched : 2013
Author Information X