gms | German Medical Science

58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

Radiographic evaluation and correlation with clinical outcome following lumbar microdiscectomy versus sequestrectomy

Korrelation klinischer und radiologischer Parameter nach Mikrodiskektomie versus Sequestrektomie

Meeting Abstract

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  • corresponding author M. Barth - Neurochirurgische Klinik, Universitätsklinikum Mannheim
  • C. Weiss - Institut für medizinische Statistik, Universitätsklinikum Mannheim
  • C. Thome - Neurochirurgische Klinik, Universitätsklinikum Mannheim

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocSA.03.01

The electronic version of this article is the complete one and can be found online at:

Published: April 11, 2007

© 2007 Barth et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Simple fragment excision in cases of herniated lumbar discs has been repeatedly reported as an alternative to standard microdiscectomy with comparable clinical results. The aim of the present study was to assess disc morphology radiologically two years after surgery in a cohort of 84 prospectively randomized patients undergoing microdiscectomy (D) or sequestrectomy (S).

Methods: Follow-up MRI was performed in all attainable patients 2 years after surgery. Disc and nondisc characteristics such as disc desiccation, loss of disc height and endplate changes plus form, size and location of canal-compromising disc lesions were assessed by a blinded neuroradiologist. Pre- and postoperative radiological data were compared and correlated with clinical outcome.

Results: The incidence of postoperative protrusions/extrusions was 70.6% for group D compared to 94.6% in group S (p=0.009). There was no positive correlation between presence of protrusion/extrusion and low back pain (LBP) or sciatica. MRI analysis revealed significant loss of disc height in more patients after microdiscectomy than sequestrectomy (63.2% vs. 37.9%; p<0.05). 47.4% of patients demonstrated an increase in modic changes 2 years after microdiscectomy compared to 13.8% after sequestrectomy (p<0.05). Endplate changes correlated with increased low back pain.

Conclusions: In particular endplate changes seem to play an important role in the etiology of unfavorable clinical outcome following disc surgery. Sequestrectomy causes less degeneration of the endplates and less segmental height loss than microdiscectomy, which seems to prove beneficial in long-term follow-up. Thus, sequestrectomy appears to be an advantageous alternative to “standard” microdiscectomy.