Success of Simple Sequestrectomy in Lumbar Spine Surgery Depends on the Competence of the Fibrous Ring

Abstract

The sole sequestrectomy group revealed similar results compared with the standard microdiscectomy group. There is a comparable low number of recurrences in both groups. This is probably caused by the consequent selection of patients for sequestrectomy according to well-defined criteria.

Is Sequestrectomy a Viable Alternative to Microdiscectomy? A Systematic Review of the Literature

“…Postoperative radicular pain or function was reported in all studies but a variety of outcome measures were used. The VAS score was the most frequently reported outcome measure with four studies reporting it [1,3,10,15]. Other outcome measures used were the Prolo scale [4,26], Oswestry Disability Index [24], SF-36 [4], Patient Satisfaction Index [4], and FFbH (Funktionsfragebogen Hannover) [15].…”

“…All but one of the studies examined demonstrated a lower recurrence rate of disc herniation in the sequestrectomy group than in the microdiscectomy group. Barth et al [4] demonstrated the highest reherniation rate of 12.5% and Kast et al [15] the lowest (1.2%) in the sequestrectomy group. Considering all the studies, reherniation rates for the sequestrectomy group are favorably comparable to that of the conventional microdiscectomy group.…”

“…This highlights the importance of longer followup studies to evaluate reherniation rates. Some of the authors emphasize the competence of the fibrous ring as a key factor in determining the reherniation rate after fragmentectomy [10,11,15]. Carragee et al [5] reported that a large annular defect measuring more than 6 mm resulted in a recurrence rate of 27.3%.…”

“…Another limitation was varying criteria for inclusion. The decision between conventional discectomy and sequestrectomy is usually made intraoperatively by the spinal surgeon by assessing the competence of the annulus with some studies defining an incompetent annulus as a contraindication to sequestrectomy [10,15,26]. Because there is some subjectivity to these findings, there could well be some selection bias in these studies that could influence the results.…”

Percutaneous Endoscopic Lumbar Herniectomy for High-Grade Down-Migrated L4–L5 Disc through an L5-S1 Interlaminar Approach: A Technical Note

“…Kast et al recently reported that the competence of the fi brous ring signifi cantly infl uenced the success of a simple sequestrectomy compared with conventional microdiscectomy in their patients. There was a comparably low number of recurrences in both groups, which was probably due to the consequent selection of patients for sequestrectomy according to well-defi ned criteria [27] . We also emphasize that for the L4 -L5 The disadvantages of this approach, similar to those associated with conventional PELD, are the steeper learning curve, expensive inventories, radiation exposure, and theoretical possibility of damage to neural structures [15] .…”