Artikel
Routine histopathological examination after nucleotomy of lumbar herniated discs is unnecessary
Die routinemäßige histopathologische Untersuchung von Bandscheibengewebe nach operativer Versorgung lumbaler Bandscheibenvorfälle ist entbehrlich
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Veröffentlicht: | 26. Juni 2020 |
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Objective: Lumbar disc herniation (LDH) is one of the most common reasons for spine surgery. Management of sciatica that is caused by LDH varies considerably and there is considerable evidence that surgical intervention provides effective clinical relief for carefully selected patients.
Histopathological examination of the disc material is routine in many hospitals. However, the clinical benefit and therapeutic consequences are very limited. The cost-effectiveness of this routine exercise should be assessed.
Methods: Histopathological reports from 1150 patients were analysed for lumbar spine discectomy between January 2013 and December 2018. The presence of a purulent or specific infection or malignancy was assessed and whether any therapeutic consequences were made according to the histopathological findings.
Results: Over a 6-year period, 1150 patients (653 men, 497 women) were examined. The average age was 53.8 years (22-87). Suppurative inflammation, specific infections or malignancies were not found in any patient. Highly degenerative and slightly regressively altered disc tissue was the finding in > 95% of cases. No granulation tissue formation, no purulent or specific granulomatous inflammation, no malignancy in 100% of cases.
Conclusion: Routine histopathological examination of discectomy material in degenerative disc disease does not provide clinically relevant data or therapeutic consequences. A multicentre study is recommended and accordingly the current practice should be changed.