Prospective comparative study of lumbar sequestrectomy and microdiscectomy.

INTRODUCTION: During microsurgical disc operation, usually a sequestrectomy and a nucleotomy are performed. Whether a nucleotomy is necessary in any case is disputed. The aim of this study is to examine this question on the basis of clinical results and to compare rates of recurrence between the two groups.

METHODS: A prospective analysis was performed in 100 patients with sequestrectomy and the first 100 consecutive patients with microdiscectomy out of a cohort of 1,245 patients, who were operated by six surgeons between 2003 and 2006. The study is designed with special emphasis on the actual pain status, the functional capacity and recurrence.

RESULTS: Despite more comorbidities the hospitalization was significantly shorter in the sequestrectomy-treated group. This group revealed more favourable results on pain scales (VAS visual analogue scale). The percentage of back pain in the discectomy-treated group was significantly higher. This went along with a significantly higher consumption of painkillers. At follow-up (34 months after surgery on average), there were no differences in the activities of daily live, measured by patient's questionnaires (ODI Oswestry low back pain disability questionnaire). Complete questionnaires were available for 46 of the sequestrectomy patients, and for 45 of the discectomy patients. Early reherniation occurred in two patients after discectomy and late reherniation in one patient after sequestrectomy.

CONCLUSIONS: Sequestrectomy alone is a safe operative modality. Sequestrectomy does not seem to entail a higher rate of recurrences compared with microdiscectomy and the results are as favourable as or better than results after discectomy.