Interdisciplinary Neurosurgery (Jun 2021)
Comparison of sequestrectomy with or without nucleotomy in patients with sequestered fragment and small perforations within the fibrous ring: 2 years’ experience
Abstract
Objective: The aim of this study was to evaluate the recurrence rate and the clinical outcomes (radicular pain, axial pain and muscle weakness) of patients undergoing sole sequestrectomy and compare them with a group treated by sequestrectomy with nucleotomy.And to verify the adequacy of the criterion used in this study to perform sequestrectomy alone. Method: Forty-eight consecutive patients 66 years of age or younger who had sequestered fragment/fragments that don't connect to nucleus pulpous and under the PLL, peridural or migrated caudally ostral in L2 - S1 levels presented in our clinic between 1/1/2018 – 1/1/2020.Patients included in this study had Fragment-Fissure herniations (characterized by disc herniation with a minimal annular defect and an extruded or sequestrated fragment) (carragee type 1).According to this criteria, we randomized equally the patients into group A (sequestrectomy without nucleotomy) [sequestrectomy wo/nucleotomy] and group B (sequestrectomy with nucleotomy) [sequestrectomy/w nucleotomy].4 patients were excluded from the study because they didn’t complete the follow-up questionnaire.Follow up of 21 months was available for the patients. A detailed analysis of the actual pain status, radicular and axial pain depending on VAS score, ODI, muscle weakness and recurrence were performed. Results: There was no statistically significant difference between the groups in terms of age, sex, comorbidities, radicular pain after surgery, muscle weakness, recurrence.ODI, The Oswestry Disability Index and axial pain postoperative were significantly lower and statically important in the sequestrectomy group.Our results clearly revealed postoperative differences in axial pain and ODI between two groups. Conclusion: Sequestrectomy alone is a safe operative modality. Patients have sequestered fragment with (Carragee type 1) findings maybe suitable to perform sequestrectomy alone because Sequestrectomy wo/nucleotomy does not seem to entail a higher rate of recurrences compared with sequestrectomy w/nucleotomy in this study and the results are as favorable as or better than results after sequestrectomy w/nucleotomy.More clinical studies are indeed to verify the adequacy of the criterion used in this study.
