Two-year outcome after lumbar microdiscectomy versus microscopic sequestrectomy -: Part 1:: Evaluation of clinical outcome

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.