HERNIECTOMY WITHOUT DISCECTOMY IN EXTRUDED LUMBAR DISC HERNIATION; SHOULD IT BE THE GOLD STANDARD?

Objective: Microdiscectomy in lumbar disc herniation (LDH) is the gold standard treatment, but conventional discectomy is still the most widely used across the world. This study aimed to evaluate the treatment outcomes of herniectomy compared to conventional discectomy for an extruded lumbar disc. Materials and Methods: A total of 788 patients were included in the study. Of this population, 548 were males and 240 were females. This was a retrospective study that was conducted from 2009 to 2018. Conventional discectomy and herniectomy for the treatment of extruded LDH were compared. Minimum follow-up period was 2 years. Results: Most of the patients were pain-free in both procedures (herniectomy and conventional discectomy). The surgical outcome of herniectomy did not significantly differ by age, gender, educational background, preoperative VAS for back, preoperative VAS for radicular pain, Oswestry disability index score, return to the previous job and level of herniation in comparison to conventional microdiscectomy. Conclusion: Herniectomy in extruded lumbar disc prolapse is similar compared to conventional discectomy in terms of pain removal and recurrent disc prolapse. Furthermore, removal of only the herniated disc preserves the disc height, which has many advantages including functional mobility and no alteration in the diameter of the intervertebral foramen. Also, a decrease in the incidence of adjacent level disc prolapse may be due to low stress in relation to conventional discectomy. It is still not clear whether the herniectomy in extruded lumbar disc surgery should be a gold standard or not.

Kaynakça

Deyo RA, Tsui-Wu YJ. Descriptive epidemiology of low-back pain and its related medical care in the United States. Spine (Phila Pa 1976). 1987;12:264-8.

Rhee JM, Schaufele M, Abdu WA. Radiculopathy and the Herniated Lumbar Disc. Controversies Regarding Pathophysiology and Management. J Bone Joint Surg Am. 2006;88:2070-80.

Schoenfeld AJ, Laughlin M, Bader JO, Bono CM. Characterization of the incidence and risk factors for the development of lumbar radiculopathy. J Spinal Disord Tech. 2012;25:163-7.

Lee J, Shin JS, Lee YJ, Kim MR, Ahn YJ, Park KB, et al. Effects of Shinbaro pharmacopuncture in sciatic pain patients with lumbar disc herniation: study protocol for a randomized controlled trial. Trials. 2015;16:455.

Teng Huang, Zhi Tian, Mengya Li, Zheng W, Zhang L, Chen J, et al. Sequestrectomy versus microdiscectomy in the treatment of lumbar disc herniation: a meta-analysis. Int J Clin Exp Med. 2015;8:72619.

Davis SJ. A long-term outcome analysis of 984 surgically treated herniated lumbar discs. J Neurosurg. 1994;80:415-21.

Yoriuitsu L, Chiba K, Toyama Y, Hirabayashi K. Long term outcomes of standard discectomy for lumbar disc herniation: a follow-up study of more than 10 years. Spine. 2001;26;652-7.

Williams RW. Microlumbar discectomy, a conservative surgical approach to the virgin herniated lumbar disc. Spine. 1978;3:75-82.

Caspar W. A new surgical procedure for lumbar disc herniation causing less tissue damage through a microsurgical approach. Lumbar Disc Adult Hydrocephalus: Springer-Verlag Berlin Heidelberg 1977,pp:74-80.

Wenger M, Mariani L, Kalbarczyk A, Gröger U. Long-term outcome of 104 patients after lumbar sequestrectomy according to Williams. Neurosurgery. 2001;49:329-34.

Hudgins R. Experience with limited versus extensive disc removal in patients undergoing microsurgical operations for ruptured lumbar discs (comment). Neurosurgery. 1988;22:85.

McCulloch JA. Focus issue on lumbar disc herniation: macro- and microdiscectomy. Spine. 1996;21:45S-56S.

Caspar W, Campbell B, Barbier DD, Kretschmmer R, Gotfried Y. The Caspar microsurgical discectomy and comparison with a conventional standard lumbar disc procedure. Neurosurgery. 1991;28:78-86.

Davis RA. A long-term outcome analysis of 984 surgically treated herniated lumbar discs. Journal of Neurosurgery. 1994;80:415-21.

Rogers LA. Experience with limited versus extensive disc removal in patients undergoing microsurgical operations for ruptured lumbar discs. Neurosurgery. 1988;22:82-5.

Williams RW. Microlumbar discectomy. A 12-year statistical review. Spine. 1986;11:851-2.

Ng LC, Tafazal S, Sell P. The effect of duration of symptoms on standard outcome measures in the surgical treatment of spinal stenosis. Eur Spine J. 2007;16:199-206.

Ostelo RW, Deyo RA, Stratford P, Waddell G, Croft P, Von Korff M, et al. Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change. Spine (Phila Pa 1976). 2008;33:90-4.

Watters WC, 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. Spine J. 2009;9:240-57.

Kaynak Göster