Sequestrectomy vs. microdiscectomy in lumbar disc herniation surgery- a prospective randomized trial
DOI:
https://doi.org/10.5457/ams.v41i2.274Keywords:
sequestrectomy, microdiscectomy, outcomeAbstract
Background: Microdiscectomy remains the standard treatment for lumbar disc herniations regardless of the increasing awareness that it might accelerate lumbar spine degeneration and aggravate back pain. Concerns that alternative surgical modalities, namely sequestrectomy, might entail increased reherniation rates are to date unsubstantiated.
Aim: The aim of the present study is to discern whether any discrepancy exists in short-term reherniation rates and clinical outcome between sequestrectomy and microdiscectomy.
Methods: The trial encompassed 75 patients randomized to either sequestrectomy (37 patients) or microdiscectomy (38 patients). Clinical outcome (as assessed by sciatica VAS, VAS back pain scores and RM scores) and radiologic alterations (disc degeneration and endplate changes) as well as propensity for recurrent herniations were analyzed in respect to the type of surgery.
Results: Back pain as assessed by mean VAS value deteriorated from 8,38 to 9,73 in sequestrectomy group, and form 5,79 to postoperative mean VAS of 24,42 in microdiscectomy group (p=0,001). There was a marked difference in disc degeneration progression (p=0,024) and endplate changes progression (p=0,003) among groups. Radiological disc degeneration correlated well with progression of back pain (p=0,002). Four patients (10,5%) in microdiscectomy group and three patients (8,1%) in sequestrectomy group ultimately developed symptomatic reherniation (p=0,515).
Conclusion: Our results suggest that microdiscectomy results in more pronounced disc degeneration as assessed by MR scans when compared to sequestrectomy. Furthermore, radiological degeneration translates to worse clinical outcome (progression of back pain). Finally, there is no difference in recurrent herniation rates between microdiscectomy and sequestrectomy.
Keywords: sequestrectomy, microdiscectomy, outcome
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