[Results of simple fragment excision in lumbar disc surgery]

While performing microsurgical disc excision, usually the sequestrated disc fragments as well as loosened or degenerated parts of the nucleus pulposus are removed. It is controversial whether this strategy is always necessary. The aim of this study was to examine this question based on clinical results.

Prospectively all relevant data from 149 consecutive patients after sequestrectomy were collected including the clinical course of the patients with a mean follow-up of 2.3 years. A detailed analysis of the actual pain status, the functional capacity and possible additional spinal operations was performed.

During early follow-up, there was one superficial wound infection, which was treated conservatively. The success rate, as measured by patient self-assessment, was 62% for excellent and good and 25% for fair results; 13% of the patients treated declared a poor result having no benefits from surgery. The average FFbH score during follow-up was 74% (100% means no functional restriction). Radicular pain and low back pain had the same intensity on the average, in contrast to some other investigations, where low back pain was lower than radicular pain [14]. Of the 149 patients, 4 underwent a second spine surgery at the same level, 2 of which were recurrent disc herniations (=1.3%).

Simple fragment excision revealed similar results compared to standard microdiscectomy. There was an especially low number of recurrences in contrast to former reports [16]. This was probably caused by the conscientious selection of patients for sequestrectomy according to well-defined criteria. Whether simple sequestrectomy can effectively treat an additional low back pain component must be clarified by further prospective studies.