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Outcome after lumbar sequestrectomy compared with microdiscectomy: a prospective randomized study
Claudius Thomé1, Martin Barth, Johann Scharf
1Department of Neurosurgery, University Hospital Mannheim, Germany. claudius.thome@nch.ma.uni-heidelberg.de
Object:
Microdiscectomy currently constitutes the standard treatment for herniated lumbar discs. Although limiting surgery to excision of fragments has occasionally been suggested, prospective data are lacking. Therefore, the objective of this study was to compare early outcome and recurrence rates after sequestrectomy and microdiscectomy.
Methods:
Eighty-four consecutive patients 60 years of age or younger who harbored free, subligamentary, or transanular herniated lumbar discs refractory to conservative treatment were randomized to one of two treatment groups. Intraoperative parameters and findings were documented as well as pre- and postoperative symptoms such as pain, Patient Satisfaction Index (PSI), Prolo Scale score, and Short Form (SF)-36 subscale results. Follow up of at least 12 months was available in 73 patients (87%). Preoperative intergroup symptoms did not differ significantly. Surgery was significantly shorter in the sequestrectomy-treated group. Overall, low-back pain and sciatica were drastically reduced in both groups and most sensorimotor deficits improved. At 4 to 6 months, SF-36 subscales and PSI scores showed a trend in favor of sequestrectomy, leaving 3% of patients unsatisfied compared with 18% of those treated with discectomy. Outcome according to the Prolo Scale was good or excellent in 76% of discectomy-treated patients and 92% of sequestrectomy-treated patients. Reherniation occurred in four patients after discectomy (10%) and two patients after sequestrectomy (5%) within 18 months.
Conclusions:
Sequestrectomy does not seem to entail a higher rate of early recurrences compared with microdiscectomy. Analysis of early outcome demonstrated a trend toward superior results when sequestrectomy is performed. Although long-term follow-up data are mandatory, sequestrectomy may be an advantageous alternative to standard microdiscectomy.
Insights
Sequestrectomy, a less invasive procedure for herniated lumbar discs, shows promising early outcomes and similar recurrence rates compared to standard microdiscectomy. This suggests sequestrectomy may be a beneficial alternative for patients.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Spinal Surgery
Background:
- Microdiscectomy is the standard surgical treatment for herniated lumbar discs.
- Limited prospective data exists comparing fragment excision (sequestrectomy) with standard microdiscectomy.
Purpose of the Study:
- To compare early outcomes and recurrence rates between sequestrectomy and microdiscectomy for herniated lumbar discs.
Main Methods:
- Eighty-four patients with herniated lumbar discs were randomized to sequestrectomy or microdiscectomy.
- Evaluated intraoperative parameters, pain, Patient Satisfaction Index (PSI), Prolo Scale, and SF-36 scores.
- Follow-up was at least 12 months for 73 patients.
Main Results:
- Sequestrectomy group had significantly shorter surgery times.
- Both groups showed significant reduction in low-back pain and sciatica.
- Sequestrectomy trended towards better SF-36 and PSI scores, with 3% unsatisfied vs. 18% for microdiscectomy.
- Good/excellent Prolo Scale outcomes were 92% for sequestrectomy vs. 76% for microdiscectomy.
- Reherniation rates were 5% for sequestrectomy and 10% for microdiscectomy.
Conclusions:
- Sequestrectomy does not appear to increase early recurrence rates compared to microdiscectomy.
- Early outcomes suggest a trend favoring sequestrectomy.
- Sequestrectomy may be a beneficial alternative to standard microdiscectomy, pending long-term data.