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Sequestrectomy Versus Conventional Microdiscectomy for the Treatment of a Lumbar Disc Herniation: A Systematic Review Publisher Pubmed



Azarhomayoun A1 ; Chou R2 ; Shirdel S3 ; Lakeh MM4 ; Vaccaro AR5 ; Rahimimovaghar V6
Authors
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Authors Affiliations
  1. 1. Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, United States
  3. 3. Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
  4. 4. Department of Community Medicine, Iran University of Medical Sciences, Tehran, Iran
  5. 5. Rothman Institute at Jefferson, Thomas Jefferson University Hospital, Philadelphia, PA, United States
  6. 6. Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Hassan-Abad Square, Imam Khomeini Ave, Tehran, Tehran, 11365-3876, Iran

Source: Spine Published:2015


Abstract

Study Design. A systematic review. Objective. The aim of this study was to compare the effects of sequestrectomy versus conventional microdiscectomy for lumbar disc herniation (LDH). Summary of Background Data. Open surgery for LDH can be performed by sequestrectomy (removal of disc fragments) or conventional discectomy (removal of disc fragments and disc). Sequestrectomy might be associated with a higher risk of recurrence but less low back pain (LBP) after surgery. Methods. We searched MEDLINE and EMBASE from 1980 to November 2014. We selected randomized controlled trials (RCTs) and nonrandomized prospective studies of conventional discectomy versus sequestrectomy for adult patients with LDH that evaluated the following primary outcomes: radicular pain or LBP as measured by a visual analog scale, or neurological deficits of the lower extremity. We also evaluated the following secondary outcomes: complications of surgery, reherniation rate, duration of hospital stay, postoperative analgesic use, and health-related quality-of-life measures. Two authors independently reviewed citations and articles for inclusion. We assessed the risk of bias, synthesized data, and the level evidence using standard methodological procedures as recommended by the Cochrane Back Review Group. Results. We identified 5 studies (746 participants) of sequestrectomy versus microdiscectomy. One study was RCT and the other 4 were nonrandomized prospective comparisons; all studies were assessed as being at a high risk of bias. There were no significant differences for leg pain, LBP, functional outcomes, complications, and hospital stay or recurrence rate for 2 years (level of evidence: Low). Sequestrectomy was associated with less analgesic consumption versus discectomy (level of evidence: Very low). Conclusion. Sequestrectomy and standard microdiscectomy were associated with similar effects on pain after surgery, recurrence rate, functional outcome, and complications; more evidence is needed to determine whether sequestrectomy is associated with less postoperative analgesic consumption. © 2015 Wolters Kluwer Health, Inc.