Success of simple sequestrectomy in lumbar spine surgery depends on the competence of the fibrous ring: a prospective controlled study of 168 patients.

Abstract

Prospective controlled clinical study. The aim of this prospective nonrandomized study is to evaluate the recurrence rate and the clinical outcome of patients undergoing sole sequestrectomy and compare them with a standard treatment group. While performing microsurgical disc excision, extruded disc fragments and loosened or degenerated parts of the nucleus are removed. It is controversial whether this strategy is always necessary. Within the literature, there is only little information about the results of exclusive sequestrectomy. Criteria for performing a sole sequestrectomy were a nonbulging disc and only small or medium perforations within the fibrous ring. According to these criteria, the authors recruited 90 patients for the sequestrectomy group. The control group was operated in standard microsurgical manner during the same time, including 84 patients. A detailed analysis of the actual pain status, the functional capacity (Hannover Activities of Daily Living Questionnaire, FFbH) and eventually additional spinal operations during the follow-up of 2 years was performed. Mean Funktionsfragebogen Hannover (FFbH) score at the follow-up was 76% in the sequestrectomy group and 77.6% in the control group. This difference is statistically not significant. There were 2 recurrences in the sequestrectomy group at the same level and 1 postoperative instability requiring a fusion procedure. In the control group, there were 2 recurrences and 1 secondary lateral spinal stenosis that led to reoperations. The competence of the fibrous ring influenced significantly the success of a simple sequestrectomy. 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.