Treatment of Lumbar Intervertebral Disc Prolapsed with Fragmentectomy, more than Ten Years Follow Up

Abstract

Background: Open lumbar discectomy is the most commonly performed surgical procedure in the spine. Conventional microdiscectomy was developed to excise the herniated and non-herniated parts of the disc, but these results in early degeneration of the disc and spine instability. Fragmentectomy was developed to excise only the herniated disc part. Objectives: To evaluate the results of fragmentectomy and more than ten years follow up of 71 patients operated at our university hospital. Methods: Seventy one patients; 43 males and 28 females with age 17 and 63 (average 36.49) years; were operated for disc prolapsed at the lumbar area. All patients were operated by single surgeon and evaluated pre and post-surgery by many surgeons. Patients were followed up for more than 10 years (on discharge, 0.25, 0.5, 1, 2, 3, 5 and 10 years). Oswestry Disability Index and the Stanford Score were used to evaluate patient outcomes. Results: Operating time ranged between 25 and 120 (average 71) minutes, blood loss 5-70 (average 35) cubic centimeters and hospital stay ranged 3-5 (4.21) days. Intraoperative a small dural tear was seen in 6 cases and postoperative hematoma in 4 cases in whom one had permanent paralysis below the know. Seven patients (0.099) needed fusion after 1-3 years. ODI decreased from around 80/100 before surgery to 20/100 after 10 years with P-Value <0.001. The Stanford score shows dramatic improvement from around 2/10 pre operation to around 9.2/10 after 10 years of follow up, P-value < 0.001 (P-value <0.001 is considered insignificant). Conclusion: Fragmentectomy or sequesterectomy is effective with fewer complications while our study size is moderate; the utility of this study is in demonstrating the long-term results of this novel intervention.