Comparison of conventional microdiscectomy and sequestrectomy in ligamentum flavum preserved lumbar disc herniation surgery

Abstract

Objective: Comparison of conventional microdiscectomy with sequestrectomy in lumbar disc herniation (LDH) surgery with ligamentum flavum (LF) preservation technique. Method: Study design was approved by local ethics committee. We retrospectively reviewed LDH 320 patients operated for disc pathologies in L3 - S1 levels in our clinic between June 2015 - June 2017. Two groups were formed in the study: sequestrectomy and conventional microdiscectomy. Demographic, operational and outcome data were compared between the groups. Results: Sequestrectomy group included 71 patients and conventional microdiscectomy group included 60 patients. There was no statistically significant difference between the groups in terms of age, sex, comorbidities, smoking, body mass index, disc pathology level, operative complications, amount of bleeding, length of stay, disc recurrence and low back pain, radicular pain, quality of life, surgical success and satisfaction results. Satisfactory improvement rates were found in the conventional discectomy (85%) and sequestrectomy group (91.5%) in mid-term follow-up. Operation time (mean 61.1 vs 94.6 min), and early postoperative opioid requirement (14.1% vs 27.1%) were significantly lower in the sequestrectomy group. Conclusions: In LDH surgery with LF preservative technique, satisfactory results were obtained with both methods with comparable. Recurrence rates and outcome. However, sequestrectomy is appropriate in cases without a wide annular defect due to the short operation time, low opioid requirement.