Long-term Clinical Outcome of the Lumbar Microdiscectomy and Fragmentectomy: A Prospective Study

Currently microdiscectomy is the standard treatment for the herniated lumbar disks. The aim of this study is to compare the long-term outcome of microdiscectomy versus sequestrectomy/free fragmentectomy for lumbar disk herniation and the effect of disk herniation type to reherniation. Disk herniations are classified into 3 categories: (a) fragment-fissure herniations, (b) fragment-defect herniations, and (c) fragment-contained herniations. Reherniation rate, annular competence, perioperative complications, operating time, the preoperative and postoperative Visual Analog Scale, Oswestry Disability Questionnaire, and the use of analgesics at the time of follow-up were compared. A total of 170 (78 sequestrectomy, 92 microdiscectomy) patients covered the inclusion criteria for study, and follow-up examinations were conducted completely. Reherniation rates did not differ significantly (2.56%, sequestrectomy; 4.34%, microdiscectomy; P>0.05). The highest recurrence rate was observed in the fragment-defect herniations group that received discectomy (10.8%). Self-rated assessment demonstrated clinical deterioration of the surgical results within the first 2 years after microdiscectomy, although they rather improved after sequestrectomy. Outcome measures at 2 years pointed in favor of sequestrectomy, with results being significant. Outcome after microdiscectomy seems to worsen over time, whereas it remains stable after sequestrectomy. The degree of annular competence seems to have effect on reoperation rate.