Comparison of Discectomy versus Sequestrectomy in Lumbar Disc Herniation: A Retrospective Cohort Study
Assessment of Lumbar Disc Herniation
DOI:
https://doi.org/10.54393/pjhs.v5i04.1348Keywords:
Discectomy, Sequestrectomy, Lumbar Disc HerniationAbstract
Lumbar disc herniation is a common spinal condition characterized by the protrusion or extrusion of intervertebral disc material. This extruded or protruded disc material compresses the spinal nerves causing various symptoms such as low back pain radiculopathy and functional limitation. Objective: To assess and compare the outcomes of pain relief as well as functional improvement among patients who underwent Discectomy and Sequestrectomy. Methods: A retrospective cohort study was conducted at the neck and surgery department, Combined Military Hospital (CMH), Quetta. A total of 80 patients were included in the study, 26 (32.5%) patients underwent Sequestrectomy while microdiscectomy was done in 54 (67.5%) patients. The data collection proforma consisted of demographic information, baseline clinical characteristics, description of surgical procedures, pre and postoperative VAS scores, and functional outcomes assessed by the Oswestry disability index. The statistics used in this study were independent t-test and paired t-tests. Results: The study results showed no significant differences in the baseline characteristics between the groups. Both procedures showed a significant improvement in pain levels, in terms of lowered VAS scores and ODI scores. Conclusions: The procedure of sequestrectomy has shown significant improvements in postoperative pain relief and functional outcomes as compared to microdiscectomy.
References
Zheng K, Wen Z, Li D. The clinical diagnostic value of lumbar intervertebral disc herniation based on MRI images. Journal of Healthcare Engineering. 2021 Apr; 2021. doi: 10.1155/2021/5594920. DOI: https://doi.org/10.1155/2021/5594920
Nichols E, Steinmetz JD, Vollset SE, Fukutaki K, Chalek J, Abd-Allah F et al. Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019. The Lancet Public Health. 2022 Feb; 7(2): e105-25. doi: 10.1002/alz.051496. DOI: https://doi.org/10.1002/alz.051496
Wei FL, Li T, Gao QY, Yang Y, Gao HR, Qian JX et al. Eight surgical interventions for lumbar disc herniation: a network meta-analysis on complications. Frontiers in Surgery. 2021 Jul; 8: 679142. doi: 10.3389/fsurg.2021.679142. DOI: https://doi.org/10.3389/fsurg.2021.679142
Yasargil MG. Microsurgical operation of herniated lumbar disc. Lumbar Disc Adult Hydrocephalus. Advances in Neurosurgery.1977; 4. doi: 10.1007/978-3-642-66578-3_16. DOI: https://doi.org/10.1007/978-3-642-66578-3_16
Ito T, Takano Y, Yuasa N. Types of lumbar herniated disc and clinical course. Spine. 2001 Mar; 26(6): 648-51. doi: 10.1097/00007632-200103150-00017. DOI: https://doi.org/10.1097/00007632-200103150-00017
Schaller B. Failed back surgery syndrome: the role of symptomatic segmental single-level instability after lumbar microdiscectomy. European Spine Journal. 2004 May; 13: 193-8. doi: 10.1007/s00586-003-0632-x. DOI: https://doi.org/10.1007/s00586-003-0632-x
Ruetten S, Komp M, Merk H, Godolias G. Recurrent lumbar disc herniation after conventional discectomy: a prospective, randomized study comparing full-endoscopic interlaminar and transforaminal versus microsurgical revision. Clinical Spine Surgery. 2009 Apr; 22(2): 122-9. doi: 10.1097/BSD.0b013e318175ddb4. DOI: https://doi.org/10.1097/BSD.0b013e318175ddb4
Parker SL, Mendenhall SK, Godil SS, Sivasubramanian P, Cahill K, Ziewacz J et al. Incidence of low back pain after lumbar discectomy for herniated disc and its effect on patient-reported outcomes. Clinical Orthopaedics and Related Research. 2015 Jun; 473: 1988-99. doi: 10.1007/s11999-015-4193-1. DOI: https://doi.org/10.1007/s11999-015-4193-1
Williams RW. Microlumbar discectomy: a conservative surgical approach to the virgin herniated lumbar disc. Spine. 1978 Jun; 3(2): 175-82. doi: 10.1097/00007632-197806000-00015. DOI: https://doi.org/10.1097/00007632-197806000-00015
Barrios C, Ahmed M, Arrótegui J, Björnsson A, Gillström P. Microsurgery versus standard removal of the herniated lumbar disc: a 3-year comparison in 150 cases. Acta Orthopaedica Scandinavica. 1990 Jan; 61(5): 399-403. doi: 10.3109/17453679008993549. DOI: https://doi.org/10.3109/17453679008993549
Ebeling U, Reichenberg W, Reulen HJ. Results of microsurgical lumbar discectomy: Review on 485 patients. Acta Neurochirurgica. 1986 Mar; 81: 45-52. doi: 10.1007/BF01456264. DOI: https://doi.org/10.1007/BF01456264
Watters III WC and McGirt MJ. An evidence-based review of the literature on the consequences of conservative versus aggressive discectomy for the treatment of primary disc herniation with radiculopathy. The Spine Journal. 2009 Mar; 9(3): 240-57. doi: 10.1016/j.spinee.2008.08.005. DOI: https://doi.org/10.1016/j.spinee.2008.08.005
Caspar W. A new surgical procedure for lumbar disc herniation causing less tissue damage through a microsurgical approach. InLumbar disc adult hydrocephalus 1977 (pp. 74-80). Berlin, Heidelberg: Springer Berlin Heidelberg. doi: 10.1007/978-3-642-66578-3_15. DOI: https://doi.org/10.1007/978-3-642-66578-3_15
Boyaci S and Aksoy K. Long-term clinical outcome of the lumbar microdiscectomy and fragmentectomy: A prospective study. Neurosurgery Quarterly. 2016 May; 26(2): 109-15. doi: 10.1097/WNQ.0000000000000138. DOI: https://doi.org/10.1097/WNQ.0000000000000138
Mochida J, Nishimura K, Nomura T, Toh E, Chiba M. The importance of preserving disc structure in surgical approaches to lumbar disc herniation. Spine. 1996 Jul; 21(13): 1556-63. doi: 10.1097/00007632-199607010-00014. DOI: https://doi.org/10.1097/00007632-199607010-00014
Faulhauer K and Manicke C. Fragment excision versus conventional disc removal in the microsurgical treatment of herniated lumbar disc. Acta Neurochirurgica. 1995 Sep; 133: 107-11. doi: 10.1007/BF01420059. DOI: https://doi.org/10.1007/BF01420059
Striffeler H, Gröger U, Reulen HJ. "Standard" microsurgical lumbar discectomy vs."conservative" microsurgical discectomy a preliminary study. Acta Neurochirurgica. 1991 Mar; 112: 62-4. doi: 10.1007/BF01402455. DOI: https://doi.org/10.1007/BF01402455
Fathallah SH, Hesham AE, Alselisly M. Evaluation of Minimal Invasive Fragmentectomy in Treatment of Lumbar Disc Prolapse. The Medical Journal of Cairo University. 2022 Mar; 90(3): 471-7. doi: 10.21608/mjcu.2022.239600. DOI: https://doi.org/10.21608/mjcu.2022.239600
Soliman J, Harvey A, Howes G, Seibly J, Dossey J, Nardone E et al. Limited microdiscectomy for lumbar disk herniation: a retrospective long-term outcome analysis. Clinical Spine Surgery. 2014 Feb; 27(1): E8-13. doi: 10.1097/BSD.0b013e31828da8f1. DOI: https://doi.org/10.1097/BSD.0b013e31828da8f1
Gupta A, Chhabra HS, Nagarjuna D, Arora M. Comparison of functional outcomes between lumbar interbody fusion surgery and discectomy in massive lumbar disc herniation: a retrospective analysis. Global Spine Journal. 2021 Jun; 11(5): 690-6. doi: 10.1177/2192568220921829. DOI: https://doi.org/10.1177/2192568220921829
Ran J, Hu Y, Zheng Z, Zhu T, Zheng H, Jing Y et al. Comparison of discectomy versus sequestrectomy in lumbar disc herniation: a meta-analysis of comparative studies. PLoS One. 2015 Mar; 10(3): e0121816. doi: 10.1371/journal.pone.0121816. DOI: https://doi.org/10.1371/journal.pone.0121816
Schmid SL, Wechsler C, Farshad M, Antoniadis A, Ulrich NH, Min K et al. Surgery for lumbar disc herniation: Analysis of 500 consecutive patients treated in an interdisciplinary spine centre. Journal of Clinical Neuroscience. 2016 May; 27: 40-3. doi: 10.1016/j.jocn.2015.08.038. DOI: https://doi.org/10.1016/j.jocn.2015.08.038
Fakouri B, Shetty NR, White TC. Is sequestrectomy a viable alternative to microdiscectomy? A systematic review of the literature. Clinical Orthopaedics and Related Research. 2015 Jun; 473(6): 1957-62. doi: 10.1007/s11999-014-3904-3. DOI: https://doi.org/10.1007/s11999-014-3904-3
Barth M, Weiss C, Thomé C. Two-year outcome after lumbar microdiscectomy versus microscopic sequestrectomy: part 1: evaluation of clinical outcome. Spine. 2008 Feb; 33(3): 265-72. doi: 10.1097/BRS.0b013e318162018c. DOI: https://doi.org/10.1097/BRS.0b013e318162018c
Huang T, Tian Z, Li M, Zheng W, Zhang L, Chen J et al. Sequestrectomy versus microdiscectomy in the treatment of lumbar disc herniation: a meta-analysis. International Journal of Clinical and Experimental Medicine. 2015; 8(5): 7261.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Pakistan Journal of Health Sciences
This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access journal and all the published articles / items are distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. For comments