Abstract
Background
Microdiscectomy involves substantial aggressive excision of disc material from the intervertebral space to prevent reherniation. However, the recent trend is towards conservative disc removal and simple fragment excision (sequestrectomy).
Aim
To compare the clinical outcome of microdiscectomy and sequestrectomy
Methods
During the 2-year study period, we performed 196 lumbar microdiscectomies for disc herniation. One hundred and one patients met the inclusion criteria: unilateral single level lumbar disc herniation. Cases suitable for sequestrectomy were based on intraoperative assessment (stable fibrous ring without significant disc bulge; posterior longitudinal ligament perforation of < 5mm).
Results
Five patients were lost to follow-up, 72 patients underwent conventional microdiscectomy and 24 patients were suitable for sequestrectomy and included in the final analysis. There was no significant difference in terms of age and pre-operative VAS in both groups (p >0.05, unpaired t test. In the microdiscectomy group, 17/31 patients with motor deficit and 34/66 patients with sensory deficit showed post-operative improvement, but in sequestrectomy group, only 1 of 5 patients with motor deficit and 8 of 13 with sensory deficit recovered but this was not statistically significant (p>0.05, Fisher's exact test).
Conclusion
In the sequestrectomy group, patients had significantly better improvement in VAS score. There was no significant difference between either group with regards to reherniation or post-operative neurological deficit. In a selected group of patients with single level lumbar disc herniation, clinical outcome of sequestrectomy is comparable to conventional microdiscectomy.
