Disc Removal: Some or All?

When the disc material between the vertebrae protrudes and gets pinched off, it forms a free-floating body inside the spinal canal. There's danger of pressure on the nearby spinal nerves. Surgery is commonly done to remove the entire disc. The idea is to prevent
another herniation. But what if the disc is left alone and just the fragment(s) is removed? That's the focus of this study from Germany.

Surgeons know that removing the entire disc causes a decrease in the height of the disc space. The ligaments and capsule around the disc get loose and become unstable. The patient can end up with more back pain. Why not leave the healthy disc tissue in place?

In this study two groups of patients with herniated lumbar discs were compared. The first group had the entire disc removed. The operation is called a discectomy. The second group had a sequestrectomy, which is just the removal of the herniated fragments.

Using leg and back pain as a measure, patients in both groups were followed for 12 months. Both groups had much less back and leg pain. Most numbness and tingling were reduced, too. Patient satisfaction was much higher in the sequestrectomy group. Only half as many patients in the sequestrectomy group had a second herniation compared to the
discectomy group.

The authors conclude that sequestrectomy may be all that's needed after disc herniation. This is especially true in cases where there has been some healing or scarring where the disc pushed through its outer covering. With a sequestrectomy, there's no need to reopen the healed disc.

Claudius Thomé, MD, et al. Outcome after Lumbar Sequestrectomy Compared With
Microdiscectomy: A Prospective Randomized Study. In Journal of Neurosurgery:
. March 2005. Vol. 2. No. 3. Pp. 271-278.

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