Lumbar microdiscectomy versus sequesterectomy/free fragmentectomy: a long-term (>2 y) retrospective study of the clinical outcome.

Study Design: Retrospective cohort study.

Objective: To compare the long-term outcome of microdiscectomy versus sequestrectomy/free fragmentectomy for lumbar disc herniation.

Summary Of Background Data: Conventional lumbar microdiscectomy involves substantial excision of disc material from the intervertebral disc space to prevent reherniation. However, in selected patients removal of free-disc fragment sequestrectomy, without clearing the disc space can be as beneficial as conventional microdiscectomy.

Methods: During the study period, we performed 196 lumbar microdiscectomies for disc herniation. Of these 101 patients met the inclusion criteria for this study. Seventy-seven of 101 patients underwent microdiscectomy and the remaining 24 patients received microscopic sequestrectomy. The following parameters were compared in these 2 groups: operating time, perioperative complications, the pre- and postoperative Visual Analog Scale (VAS), reherniation rate, and the use of analgesics at the time of follow-up. The patients were assessed at the final follow-up. Mean follow-up was 33.4 (24 to 47) months in the sequestrectomy group and 32.4 (24 to 45) months in the microdiscectomy group.

Results: The operating time for the microdiscectomy patients was longer than that for the sequestrectomy patients, 32 (19 to 51) versus 24 (15 to 40) minutes. The reherniation rate was slightly lower in the sequestrectomy group than in the microdiscectomy group, 4.17% versus 5.56%. (P=1.00). The complication rate was higher in the microdiscectomy population, 6.4% versus 4.17%. Postoperative improvement in pain in the sequestrectomy group was slightly better than that in the microdiscectomy cohort, VAS 1.6 versus VAS 1.2. (P=0.06).

Conclusions: We argue that microscopic sequestrectomy is more successful with lesser operating time, fewer intraoperative complications, and lesser reherniation rate compared with conventional microdiscectomy in which patients are selected according to well-defined criteria, which is largely dependent on the competence of the annulus/posterior longitudinal ligament.