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Two-year outcome after lumbar microdiscectomy versus microscopic sequestrectomy: part 1: evaluation of clinical outcome.

Barth M, Weiss C, Thomé C

Department of Neurosurgery, University Hospital Mannheim, Medical Faculty Mannheim of the Ruprecht-Karls-University of Heidelberg, Germany.

STUDY DESIGN: Single-center randomized prospective study at a university hospital. OBJECTIVE: The aim of the present study was to provide a 2-year outcome comparison of microdiscectomy (D) versus microscopic sequestrectomy (S) in terms of reherniation rates, clinical investigation, and self-rated parameters using a comprehensive questionnaire. SUMMARY OF BACKGROUND DATA: Simple fragment excision in cases of herniated lumbar discs has been repeatedly reported as an alternative to standard microdiscectomy, but prospective data with sufficient follow-up is lacking to date. Preliminary results of a prospective randomized study in patients with lumbar disc herniations indicated equal reherniation rates and a trend toward superior clinical results in patients undergoing only sequestrectomy after 4 to 6 months. MATERIAL AND METHODS: Eighty-four patients with lumbar disc herniations were treated with microdiscectomy or microscopic sequestrectomy in equal parts. Patients were re-evaluated thoroughly clinically after 2 years. Results of this investigation (low back pain, sciatica, motor-, sensory-, reflex-, straight leg raising test-indexes) and self-rated parameters including SF-36 were analyzed for differences between groups and between time points. RESULTS: Thirty-eight (D) and 40 (S) patients were attainable for follow-up. Reherniation rates did not differ significantly (10.5%, group D; 12.5%, group S; P = 1.0). Following dramatic improvement after surgery in both groups, results of the clinical investigation remained stable over time without significant differences between groups. In contrast, self-rated assessment demonstrated clinical deterioration of the surgical results within the first 2 years after microdiscectomy, while they rather improved after sequestrectomy. Because of this development, the outcome measures at 2 years pointed in favor of sequestrectomy with results being significant for important parameters such as use of analgesics, performance, and overall outcome. CONCLUSION: Reherniation rates within 2 years after sequestrectomy and microdiscectomy are comparable. However, outcome after microdiscectomy seems to worsen over time, whereas it remains stable after sequestrectomy. Thus, 2-year follow-up revealed clinical results favoring sequestrectomy. Performing sequestrectomy alone may therefore represent an advantageous alternative to standard microdiscectomy.

Published 27 February 2008 in Spine, 33(3): 265-72.
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