The treatment of lumbar disc herniation: simple fragment excision versus disc space curettage

The purpose of this study was to determine whether there was any difference in the clinical outcome between groups of patients treated with lumbar discectomy and vertebral endplate curettage as compared with disc fragment excision without endplate curettage. Eighty-three patients requiring lumbar disc excision for herniated nucleus pulposus were evaluated retrospectively at minimum 2-year follow-up. Forty-three patients had undergone fragment excision and disc space curettage at one center, whereas 40 patients underwent fragment excision without curettage at two other centers. There was no increased rate of reherniation or reoperation in the excision-only group. Vertebral endplate curettage carries a risk of annular penetration and damage to the great vessels. This study shows that this potentially dangerous step of the operation is unwarranted. In addition, patients who underwent endplate curettage had a higher incidence of low-back pain on follow-up.