Long term results of lumbar sequestrectomy versus aggressive microdiscectomy

Kotıl, Kadır; Köksal, Neslihan Sütpideler; Kayacı, Selim

doi:10.1016/j.jocn.2014.01.012

Cited by 11 publications

(15 citation statements)

References 19 publications

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“…According to the searching strategy illustrated in Fig. 1 , 12 eligible comparative studies were identified, including one randomized controlled trial [ 13 ], 5 prospective comparative studies [ 18 – 22 ] and 6 retrospective comparative studies [ 23 – 28 ]. Two [ 18 , 22 ] of the 12 studies were historical comparative and sequestrectomy was prior to discectomy, other studies all consisted of contemporary groups.…”

Section: Resultsmentioning

confidence: 99%

Comparison of Discectomy versus Sequestrectomy in Lumbar Disc Herniation: A Meta-Analysis of Comparative Studies

Ran

Zheng

et al. 2015

PLoS ONE

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BackgroundLumbar disc removal is currently the standard treatment for lumbar disc herniation. No consensus has been achieved whether aggressive disc resection with curettage (discectomy) versus conservative removal of the offending disc fragment alone (sequestrectomy) provides better outcomes. This study aims to compare the reherniation rate and clinical outcomes between discectomy and sequestrectomy by literature review and a meta-analysis.MethodsA systematic search of PubMed, Medline, Embase and the Cochrane Library was performed up to June 1, 2014. Outcomes of interest assessing the two techniques included demographic and clinical baseline characteristics, perioperative variables, complications, recurrent herniation rate and post-operative functional outcomes.ResultsTwelve eligible trials evaluating discectomy vs sequestrectomy were identified including one randomized controlled study, five prospective and six retrospective comparative studies. By contrast to discectomy, sequestrectomy was associated with significantly less operative time (p<0.001), lower visual analogue scale (VAS) for low back pain (p<0.05), less post-operative analgesic usage (p<0.05) and better patients’ satisfaction (p<0.05). Recurrent herniation rate, reoperation rate, intraoperative blood loss, hospitalization duration and VAS for sciatica were without significant difference.ConclusionsAccording to our pooled data, sequestrectomy entails equivalent reherniation rate and complications compared with discectomy but maintains a lower incidence of recurrent low back pain and higher satisfactory rate. High-quality prospective randomized controlled trials are needed to firmly assess these two procedures.

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Section: Resultsmentioning

confidence: 99%

Comparison of Discectomy versus Sequestrectomy in Lumbar Disc Herniation: A Meta-Analysis of Comparative Studies

Ran

Zheng

et al. 2015

PLoS ONE

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“…Beside the rationale for this technique, already detailed above, another technical aspect deserves attention: it is well known that annular defect size is associated with recurrent disc herniation, 25 therefore the simple removal of the migrated disc fragment without formal discectomy is itself a measure to minimize the annular defects or fissures. In fact, our literature search allowed to identify several articles supporting the use of lumbar microscopic sequestrectomy, 12,13,27,28 or endoscopic discectomy, 22,[29][30][31][32] nonetheless only few authors proposed endoscopic approaches for lumbar sequestrectomies. Of note, some endoscopic spine systems conceived for posterolateral approach to the lumbar disc through psoas muscle splitting allow for a tailored lateral decompression while sparing the patients from risk of postoperative paraspinal muscles wasting, nonetheless this surgical route prevents surgeons from being able to perform selective foraminotomies and sequestrectomies.…”

Section: Discussionmentioning

confidence: 99%

A Pilot Study of Percutaneous Interlaminar Endoscopic Lumbar Sequestrectomy: A Modern Strategy to Tackle Medically-Refractory Radiculopathies and Restore Spinal Function

et al. 2019

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Objective: Angled scopes allow 360° visualization, which makes percutaneous endoscopic techniques (percutaneous endoscopic lumbar discectomy, PELD) particularly attractive for sequestrectomies, which entail the removal of extruded lumbar disc fragments that have migrated caudally or cranially between the ligaments, foramina, and neural structures, while preserving the disc. Although many different PELD techniques are currently available, not all of them are suitable for sequestrectomies; furthermore, long-term follow-up data are unfortunately lacking. Methods: A pilot study was conducted on a cohort of 270 patients with lumbar radiculopathy undergoing minimally invasive spine surgery (PELD or microdiscectomy), of whom only 7 were eligible for endoscopic interlaminar sequestrectomy with disc preservation. The patients' baseline conditions and clinical outcomes were measured with the Oswestry Disability Index and a visual analogue scale. Long-term follow-up was conducted using satisfaction questionnaires that were based on the MacNab criteria and administered by medical/nursing personnel not involved in their primary surgical management. Results: EasyGo system was eventually used in 5 PELD cases. No dural tears, infections, or nerve root injuries were recorded in patients undergoing sequestrectomy. Surgical events, including blood loss and overall length of hospital stay, did not differ significantly among the 270 patients. In the group treated with endoscopic sequestrectomy, no recurrences or complications were noted during a follow-up of 3 years, and an excellent degree of satisfaction was reported. Conclusion: We provide OCEBM (Oxford Centre for Evidence-Based Medicine) level 3 evidence that interlaminar endoscopic sequestrectomy is a tailored and well-tolerated surgical option; nonetheless, a cost-effectiveness analysis assessing the interval until return to working activities and long-term benefits is warranted.

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“…In a study performed with ODI, it was reported that the quality of life was worse in the sequestrectomy group in the 1 and 5year follow-up results. 23 In contrast, another study observed that the effect of conventional microdiscectomy on the quality of life results was more negative according to the ODI scores after a two year follow-up. 29 When the success of the operation and patient satisfaction were evaluated, it was found that high rates of improvement were observed in both groups in our series.…”

Section: Discussionmentioning

confidence: 94%

“…In addition, the majority of previous studies have shown that the surgical duration of sequestrectomy is significant shorter. [20][21][22][23] In contrast, Shamji et al 24 showed that there was no difference in total surgical length between two methods. However, it should be noted that in their study, two methods were applied by two different surgeons.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of conventional microdiscectomy and sequestrectomy in ligamentum flavum preserved lumbar disc herniation surgery

Özöner

Canbolat²

2019

Cumhuriyet Medical Journal

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Comparison of conventional microdiscectomy with sequestrectomy in lumbar disc herniation (LDH) surgery with ligamentum flavum (LF) preservation technique. Method: Study design was approved by the local ethics committee. We retrospectively reviewed LDH 320 patients operated for disc pathologies in L3-S1 levels in our clinic between June 2015-June 2017. Two groups were formed in the study: sequestrectomy and conventional microdiscectomy. Demographic, operational and outcome data were compared between the groups. Results: Sequestrectomy group included 71 patients and conventional microdiscectomy group included 60 patients. There was no statistically significant difference between the groups in terms of age, sex, comorbidities, smoking, body mass index, disc pathology level, operative complications, amount of bleeding, length of stay, disc recurrence and low back pain, radicular pain, quality of life, surgical success and satisfaction results. Satisfactory improvement rates were found in the conventional discectomy (85%) and sequestrectomy group (91.5%) in the mid-term follow-up. Operation time (mean 61.1 vs 94.6 min), and early postoperative opioid requirement (14.1% vs 27.1%) were significantly lower in the sequestrectomy group. Conclusions: In LDH surgery with LF preservative technique, satisfactory results were obtained with both methods with comparable. Recurrence rates and outcome. However, sequestrectomy is appropriate in cases without a wide annular defect due to the short operation time, low opioid requirement.

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Long term results of lumbar sequestrectomy versus aggressive microdiscectomy

Cited by 11 publications

References 19 publications

Comparison of Discectomy versus Sequestrectomy in Lumbar Disc Herniation: A Meta-Analysis of Comparative Studies

Comparison of Discectomy versus Sequestrectomy in Lumbar Disc Herniation: A Meta-Analysis of Comparative Studies

A Pilot Study of Percutaneous Interlaminar Endoscopic Lumbar Sequestrectomy: A Modern Strategy to Tackle Medically-Refractory Radiculopathies and Restore Spinal Function

Comparison of conventional microdiscectomy and sequestrectomy in ligamentum flavum preserved lumbar disc herniation surgery

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