gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

Sequestrectomy versus "standard" microdiscectomy in the treatment of sequestrated lumbar disc prolapse: A randomized prospective clinical trial

Sequestrektomie versus “Standard”-Mikrodiskektomie zur Therapie von sequestrierten lumbalen Bandscheibenvorfällen: Eine randomisierte, prospektive, klinische Studie

Meeting Abstract

Suche in Medline nach

  • corresponding author Claudius Thomé - Neurochirurgische Klinik, Universitätsklinikum Mannheim, Mannheim
  • M. Barth - Neurochirurgische Klinik, Universitätsklinikum Mannheim, Mannheim
  • P. Schmiedek - Neurochirurgische Klinik, Universitätsklinikum Mannheim, Mannheim

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocMI.04.05

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2004/04dgnc0274.shtml

Veröffentlicht: 23. April 2004

© 2004 Thomé et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

Removal of the disc or nucleus during “standard” microdiscectomy has been thought to accelerate segmental degeneration. In order to minimize surgical trauma, limiting surgery of sequestrated lumbar discs to fragment excision has occasionally been suggested. It has been argued, however, that high recurrence rates would ensue. The objective of this study was to prospectively compare the surgical parameters and early outcome of only sequestrectomy (S) with sequestrectomy plus microdiscectomy (M).

Methods

80 consecutive patients aged less than 60 years (41±10) with sequestrated lumbar discs were randomized to the treatment groups (S, M). Intraoperative parameters were assessed as well as pre- and postoperative symptoms, pain (VAS; 0-10), Patient Satisfaction Index (PSI), Prolo Scores and SF-36 using standardized questionnaires. 3-months follow-up was available on 60 patients (75%).

Results

Preoperative symptoms did not differ between the groups. At surgery, most fragments were located below the posterior longitudinal ligament (68.5%) and perforation of the anulus could be seen in 51.4%. In 32.9% of cases the fragment was partially located in the disc space. Duration of surgery was significantly reduced by sequestrectomy to 32±14min vs. 38±10min (p<0.05). Blood loss did not differ between the groups (78±62ml (M) vs. 67±85ml (S)). Postoperative wound pain amounted to 3.2±1.7 (M) and 3.1±1.7 (S) (n.s.). There were no complications except for one superficial wound infection in the microdiscectomy group. Within 3 months there were 2 recurrences after microdiscectomy (6.5%) and 1 after sequestrectomy (3.4%; n.s.). Back pain was rated 1.6±2.8 (M) vs. 0.9±1.4 (S). Both Prolo Scores and PSI showed a trend in favor of sequestrectomy leaving 3.6% of patients unsatisfied vs. 17.2% after microdiscectomy (n.s.).

Conclusions

Performing sequestrectomy without microdiscectomy for sequestrated lumbar discs does not seem to entail a higher rate of early recurrences. After 3 months, outcome shows a trend to superior results after limited surgery. Although long-term follow-up is mandatory, sequestrectomy may be an advantageous alternative to “standard” microdiscectomy.