Artikel
Two-year clinical outcome following lumbar microdiscectomy versus sequestrectomy
Evaluation des klinischen Outcome nach Mikrodiskektomie versus Sequestrektomie
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Veröffentlicht: | 11. April 2007 |
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Gliederung
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Objective: Simple fragment excision in cases of herniated lumbar discs has been repeatedly reported as an alternative to standard microdiscectomy, but prospective clinical data with sufficient follow-up is lacking to date. The aim of the present study was to provide a two-year outcome comparison of microdiscectomy (D) versus sequestrectomy (S) in terms of reherniation rates, clinical investigation, and self-rated parameters using a comprehensive questionnaire.
Methods: 84 patients with lumbar disc herniations were treated with microdiscectomy or sequestrectomy in equal parts. Patients were reevaluated thoroughly clinically after 2 years. Results of this investigation (low back pain, sciatica, motor-, sensory-, reflex-, straight leg raising test-indices) and self-rated parameters including SF-36 were analyzed for differences between groups and between time points.
Results: 35 (D) and 38 (S) patients were attainable for clinical follow-up. Reherniation rates did not differ between groups. Following postoperative improvement in both groups, self-rated assessment demonstrated clinical deterioration of the surgical results within the first 2 years after microdiscectomy, while they improved after sequestrectomy. Favorable outcome was achieved in 97.4% after sequestrectomy and in 88.6% after microdiscectomy (p<0.05). 42.9% of microdiscectomy patients needed analgesics 2 years after surgery compared to 21.1% after sequestrectomy (p<0.05).
Conclusions: Reherniation rates within 2 years after sequestrectomy and microdiscectomy are comparable. However, outcome after microdiscectomy seems to worsen over time, while it remains stable after sequestrectomy. Thus, two-year follow-up revealed clinical results favoring sequestrectomy. Performing sequestrectomy alone may therefore represent an advantageous alternative to standard microdiscectomy.