Article
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
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Authors
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Claudius Thomé
- Neurochirurgische Klinik, Universitätsklinikum Mannheim, Mannheim
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M. Barth
- Neurochirurgische Klinik, Universitätsklinikum Mannheim, Mannheim
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P. Schmiedek
- Neurochirurgische Klinik, Universitätsklinikum Mannheim, Mannheim
| Published: | April 23, 2004 |
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Outline
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.
