Limited versus Aggressive Open Discectomy for a Single Level Lumbar Intervertebral Disc Prolapse

Open lumbar discectomy is the gold standard surgical procedure for intervertebral disc herniation but still controversy exit whether limited or aggressive open discectomy provides better outcomes. Retrospectively we evaluate 2380 patients to compare the clinical outcomes, complications and recurrence rate between limited (LD) and aggressive open discectomy (AD). Records of 745 men and 255 women aged 19 to 55 (mean, 38.03±9.1) years for LD and 995 men and 385 women aged 21 to 60 (mean, 43.7±9.3) years for AD were reviewed. Demographic data, surgical data, complications and re-herniation rate were collected and assessment done by Visual analogue score (VAS), Oswestry Disability Index (ODI) and modified Mcnab criteria. The mean follow-up period was 24.5 and 28.8 months respectively. In compare to aggressive discectomy, limited discectomy required significantly less operative time (95 vs. 55 minutes, p<0.001, unpaired 't' test), less used of post-operative analgesic (p<0.05) and better patients' satisfaction (p<0.05). But low back pain, leg pain, recurrence rate, infection, per-operative blood loss and periods of hospitalization were without significant difference. Both groups achieved satisfactory clinical outcomes 85%, 78.62 % respectively. Complications were foot drop (n=2, 5), dural tear (n=7, 14), superficial wound infection (n=7, 17) and discitis (n=19, 37) and reherniation (55, 64) respectively. Limited discectomy is an alternative to the aggressive discectomy. Both groups showed satisfactory outcome but in limited discectomy group shown better satisfaction in relation to aggressive discectomy.