Lumbar Microdiscectomy Versus Sequesterectomy/Free Fragmentectomy

Abstract

We argue that microscopic sequestrectomy is more successful with lesser operating time, fewer intraoperative complications, and lesser reherniation rate compared with conventional microdiscectomy in which patients are selected according to well-defined criteria, which is largely dependent on the competence of the annulus/posterior longitudinal ligament.

Fragmentectomy versus Conventional Microdiscectomy in Single-Level Lumbar Disc Herniations : Comparison of Clinical Results and Recurrence Rates

“…Visualization of and instrument accessibility to the intervertebral disc space are limited. Furthermore, there is the possibility of the failed back syndrome related to diminished disc height1,6,7,14,15,17). Thus, we attempted to remove the normal disc materials as little as possible and eventually performed only fragmentectomy.…”

“…They also reported that patients with stable fibrous rings and small defects (3 mm or less) had a good success rate. Fakouri et al6) reported successful sequestrectomy in patients who met their inclusion criteria : the free disc fragment was localized posterior to the PLL and the annular tear was up to 5 mm without significant bulging of the disc. This decision was made intraoperatively by assessing the integrity of the annulus fibrosus and the PLL, but the determinations were very subjective and dependent on each surgeon's experience.…”

“…Fragmentectomy showed good success rates of greater than 90%, according to some studies7,14,16). However, such results cause spinal surgeons to debate whether recurrent disc herniation would increase after fragmenectomy6). Therefore, this retrospective study was conducted to compare the clinical outcomes of fragmentectomy and conventional microdiscectomy in patients with single-level LDH in terms of pain relief and recurrence rate.…”

“…In 1977 Caspar5) and Yasargil20) introduced an interlaminar approach with partial resection of bony structures and the ligamentum flavum followed by the removal of the intervertebral disc materials6). Since then, various techniques have been developed for the treatment of lumbar disc herniation (LDH), but most patients still undergo the conventional microdiscectomy2).…”

“…Furthermore, aggressive discectomy often causes postoperative loss of disc height with subsequent loosening of ligaments and articular capsules11,12). This may result in segmental instability and thus accelerate spondylosis, which contributes to a significant proportion of failed back surgery syndrome after lumbar microdiscectomy1,6,7,14,15,17). For these reasons, in 1978, Williams19) proposed a conservative microsurgical approach to virgin herniated lumbar discs by making only a blunt perforation in the fibrous annular ring without an incision or curettage of the disc space.…”