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Clinical Orthopaedics and Related Research®

, Volume 473, Issue 6, pp 1957–1962 | Cite as

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

  • Bahram FakouriEmail author
  • Nitin R. Shetty
  • Thomas C. H. White
Symposium: Current Approaches to the Management of Lumbar Disc Herniation

Abstract

Background

Traditionally, lumbar discectomy involves removal of the free disc fragment followed by aggressive or conservative excision of the intervertebral disc. In selected patients, however, it is possible to remove only the free fragment or sequester without clearing the intervertebral disc space. However, there is some controversy about whether that approach is sufficient to prevent recurrent symptoms and to provide adequate pain relief.

Questions/purposes

This systematic review was designed to pose two questions: (1) Does performing a sequestrectomy only without conventional microdiscectomy lead to an increased reherniation rate; and (2) is there a difference in the patient-reported levels of radicular pain?

Methods

Systematic MEDLINE and EMBASE searches were carried out to identify all articles published in peer-reviewed journals reporting the outcomes of interest for conventional microdiscectomy versus sequestrectomy for lumbar disc herniation from L2 to the sacrum (Level III evidence and above); hand-searching of bibliographies was also performed. A minimum of Level II evidence was required with a followup rate of greater than 75%. Followup in all studies was from 18 to 86 months. Seven studies met the inclusion criteria for this review. The studies were analyzed for operating time, hospital stay, pre- and postoperative visual analog scale, and reherniation rate.

Results

Patients in both the microdiscectomy and sequestrectomy groups showed comparable improvement of visual analog scale (VAS) score for leg pain. VAS score improvement ranged from 5.6 to 6.5 points in the microdiscectomy groups and 5.5 to 6.6 in the sequestrectomy group. The reherniation rate in the microdiscectomy group ranged from 2.3% to 11.8% and in the sequestrectomy groups from 2% to 12.5%.

Conclusions

This review of the available literature suggests that, compared with conventional microdiscectomy, microsurgical lumbar sequestrectomy can achieve comparable reherniation rates and reduction in radicular pain when a small breach in the posterior fibrous ring is found intraoperatively.

Keywords

Visual Analog Scale Score Disc Herniation Lumbar Disc Herniation Radicular Pain Lumbar Discectomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© The Association of Bone and Joint Surgeons® 2014

Authors and Affiliations

  • Bahram Fakouri
    • 1
    Email author
  • Nitin R. Shetty
    • 1
  • Thomas C. H. White
    • 1
  1. 1.Guys and St Thomas’ HospitalLondonUK

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