Microdiscectomy Versus Sequestrectomy: Which Has Better Results?
Studies over time have resulted in changes in the surgical treatment for disc herniation. At one time, the entire disc was removed but not replaced. In 1977, the microdiscectomy was introduced as a more minimal approach to disc removal. With this procedure, the disc is removed using a very small incision. There is minimal disruption of the ligaments and bony structure.
Today, sequestrectomy has been suggested as a modification to microdiscectomy. With sequestrectomy, only the loose fragments of disc material in the intervertebral space are removed. The disc space is not entered at all. The advantages of sequestrectomy over microdiscectomy are reported in this study.
Two groups of patients with a single-level lumbar herniation were compared. None of the patients had a previous spine surgery. One group had a standard discectomy. All disc material at the affected level was removed. The second group had a sequestrectomy: only free-floating disc fragments were taken out.
The short-term results (four to six months) for these two groups were reported in an earlier study. Long-term results after two years were the focus of this report. Outcome measures included pain, self-rated quality of life, and rate of reherniation. Both groups had good improvement in pain. Over time, the microdiscectomy group reported worse symptoms and increased use of pain medication.
Improved function was observed in the sequestrectomy group and did not decline over time. On the other hand, function declined in the microdiscectomy group. Function was measured in terms of sleep, work, and play (sports). After two years, the reherniation rate was the same for both groups.
The authors conclude that sequestrectomy is a superior treatment over microdiscectomy for disc herniation. Removing only the disc fragments that are pressing on the spinal nerve root is all that's needed for good results. Concern about reherniation after sequestrectomy was not supported by this study. For the best results, surgeons should continue to remove as little disc material as possible. Healthy disc tissue should not be touched.
Martin Barth, MD, et al. Two-Year Outcome After Lumbar Microdiscectomy Versus Microscopic Sequestrectomy. In Spine. February 1, 2008. Vol. 33.No. 3. Pp. 265-272.