Conventional Discectomy Research Articles

Percutaneous Endoscopic Spine Surgery for Extruded Lumbar Disc Herniation

The conventional open discectomy is the gold standard for treating extruded lumbar disc herniation, especially in highly migrated lumbar disc herniation. Endoscopic spine surgery is known to be very challenging and technically demanding, in particular for highly migrated disc herniation. However, several studies have reported numerous effective techniques with results approximatively equal to conventional open surgeries or mini-open surgery. In the last few years, an increased number of endoscopic spine surgical techniques have been proposed in order to overcome various issues encountered in traditional endoscopic spine surgery. Nevertheless, surgical approach selection for treating extruded lumbar disc herniation is based on aspects such as anatomical structures, availability of surgical instruments, surgeon’s experience, and the disc herniation location. Advances in endoscopic visualization and instrumentation, as well as an increased demand for minimally invasive procedures, have led to the popularity of Percutaneous Endoscopic Lumbar Discectomy (PELD). PELD is a recent and advanced technique among other minimally invasive spine surgeries (MIS). It includes various kinds of surgical techniques to treat lumbar disc herniation and aims to offer a safe, less invasive surgical procedure for lumbar disc space decompression and removal of nucleus pulposus.

How I do it: percutaneous transforaminal endoscopic discectomy for lumbar disk herniation

BackgroundPercutaneous transforaminal endoscopic discectomy (PTED) has emerged as a less invasive technique to treat symptomatic lumbar disk herniation (LDH). PTED is performed under local anesthesia with the advantage of immediate intraoperative feedback of the patient. In this paper, the technique is described as conducted in our hospital.MethodsPTED is performed under local anesthesia in prone position on thoracopelvic supports. The procedure is explained stepwise: e.g. marking, incision, introduction of the 18-gauge needle and guidewire to the superior articular process, introduction of the TomShidi needle and foraminotomy up to 9 mm, with subsequently removal of disk material through the endoscope. Scar size is around 8 mm.ConclusionPTED seems a promising alternative to conventional discectomy in patients with LDH and can be performed safely.

PEID (Percutaneous Endoscopic Interlaminar Discectomy): Cautionary Points Based on the Evidence

Background: Percutaneous endoscopic lumbar discectomy (PELD) is one of the most sophisticated operative procedures for the treatment of lumbar disc herniation (LDH). Endoscopic techniques are now becoming standard in many areas due to expanded technical possibilities of full-endoscopic transforaminal or interlaminar resection of herniated lumbar discs as well as stenosis. However conventional percutaneous endoscopic interlaminar discectomy (PEID) disc operations may sometimes result in subsequent untoward complications due to unnoticed iatrogenic trauma to neural structures, which is mostly related to an anatomical limitation during endoscope insertion.Methods: An appropriate operative indication of the PEID without bone removal or laminectomy can be used to treat LDH cases with an enough interlaminar space (at least ≥ 20 mm by bi-facetal distance) from the reported evidences. Otherwise, there might be several indications for requirement of bone removal; a narrow interlaminar space, disappearance of the concave shape of the upper vertebral laminae, high-grade migration of LDH, recurrent LDH, obesity, or an immobile nerve root.Conclusion: The significance of PEID lies also in its minimal damage to surrounding structures such as muscle, bone, and ligaments. A discrete radiographic evaluation from the patient preoperatively is mandatory before choosing a proper endoscopic surgical modality for the sake of optimal clinical outcome after PEID.

Percutaneous endoscopic discectomy: Gold standard technique for single level intervertebral disc prolapse

Introduction: DISC prolapse is a common problem seen in general population and 10% patients may require surgical intervention. Objective: To determine functional outcome of patients operated by percutaneous endoscopic discectomy. Methodology: Study Area: New Civil Hospital Surat. Sample Size: 40 Scores used: VAS and Oswestry Disability Index Results: Patients operated for Disc Herniation by percutaneous discectomy were followed up 1 month 3 months and 6 months postoperatively showing immediate pain relief, smaller incision size, almost no blood loss and earlier return to daily activities. Conclusion: Endoscopic discectomy is a newer technique which is practised now a days for PIVD and it shows better results than conventional discectomy in terms of post op pain the amount of blood loss, post op ambulation and anesthesia given. It can now be said that percutaneous endoscopic discectomy is the GOLD standard surgical technique for single level disc prolapse.

Clinical Outcomes of Hernia Nucleous Pulposus after Microendodiscectomy

There are several options of surgical treatment of Hernia Nucleous Pulposus (HNP) such as discectomy and micro-endodiscectomy (MED). The fundamental differences between these procedures are the size of the incision, the discectomy procedure and the volume of disc taken. However, until now, there has not been any class 1 evidences explaining the efficacy of these procedures, and there is only a few studies about its safety and factors influencing its efficacy in treating HNP, especially in Indonesia. This study is aimed to assess clinical outcomes and safety of MED in HNP patients who underwent this procedure. Patient with HNP who underwent MED were followed prospectively in a period of January 2015 until December 2016. Clinical outcomes were evaluated by using Visual Analog Score (VAS) for assessing back pain and leg, and Oswestry Disability Index (ODI). The mean of pre-treatment score was compared with the mean of post-surgical treatment score by using paired t-test. Sampel were 78 HNP patients treated surgery. The average surgery duration (± SD) was 60 ± 17.1 minutes. The pretreatment score mean on VAS and ODI were 4.88 ± 1.10 and 35.21 ± 8.24. After surgical treatment, the VAS and ODI score obtained were significantly reduced to 1.53 ± 1.14 and 5.16 ± 5.52, respectively (p<0,001). A type of complication was observed, which was 5 (6.4%) cases of dural tear; no deficit in ankle dorsiflexion nor foot paresis were found. MED has been shown to be able to treat HNP with clinical outcomes similar to conventional open discectomy but with better levels of safety and effectiveness. However, this procedure still requires high quality randomized controlled trials studying about its efficacy and cost effectiveness in HNP treatment.

Comparative outcomes of epidural steroids versus placebo after lumbar discectomy in lumbar disc herniation: a systematic review and meta-analysis of randomized controlled trials.

Treatment for lumbar disc herniation after failed conservative treatment is discectomy. Discectomy can significantly relieve back pain as well as radicular symptoms. However, many patients with lumbar discectomy experience moderate-to-severe back pain and radicular leg pain. The results of application of epidural steroids (ES) for pain management after lumbar discectomy have previously been inconclusive. We have conducted a systematic review and meta-analysis aims to compare outcomes (efficacy and complications) of epidural steroid application and placebo after discectomy in lumbar disc herniation. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Relevant studies that reported visual analog scale of back and leg pain, morphine consumption, hospital stay and post-operative complications of either group were identified from Medline and Scopus from the date of inception to 28 October 2017. A total of 12 studies were pooled and analysed, with nine studies having undergone conventional discectomy and three studies having undergone minimally invasive surgery (MIS) discectomy. Overall, there were 1006 patients (502 in the ES group and 504 in the placebo group) included. The unstandardized mean difference of VAS of back pain at 1week and 1month, leg pain at 1week and 1month, morphine consumption and hospital stay was -0.53 (95% CI -1.42, 0.36) score, -0.89 (95% CI -1.36, -0.42) score, -0.63 (95% CI -0.75, -0.50) score, -0.47 (95% CI -0.78, -0.15) score, -8.47 (95% CI -16.16, -0.78) mg and -0.89 (95% CI -1.49, -0.30) days lower when compared to placebo after lumbar discectomy in patients with lumbar disc herniation. A total of ten studies compared the ratio of complication between the ES and placebo groups. No significant differences were noted for complications within the two groups (0.92; 95% CI 0.47, 1.83). This meta-analysis analysed lower back and leg pain, morphine consumption and hospital stay, with no significant difference in complications for ES application after lumbar discectomy in lumbar disc herniation. In terms of surgical approaches with MIS compared to conventional approach, this review demonstrates that ES can reduce post-operative morphine consumption when the surgical approach is conventional, but not for MIS.Level of evidence I.

Preliminary Clinical Outcomes From The Polyetheretherketone On Ceramic Simplify™ Disc FDA IDE Trial

Background: This study was performed to evaluate the preliminary clinical results for the Simplify™ Cervical Artificial Disc. Methods: We compared outcomes for the first 61 subjects to reach Month 12 follow-up in a prospective, multicenter, FDA IDE clinical trial with 61 propensity score matched historical control subjects who received conventional anterior cervical discectomy and fusion (ACDF) for single-level cervical degenerative disc disease. The outcome measures included the change from preoperative baseline to Month 12 in Neck Disability Index (NDI) and visual analog scales (VAS) for neck and arm pain with missing follow-up determined by last observation carried forward. Results: The null hypothesis that the Simplify 1-disc is inferior to ACDF (non-inferiority margin=8.4) was rejected at a 1-sided p<0.0001. The upper bound of the 1-sided 95% non-inferiority confidence interval was -7.44 which is much smaller than the non-inferiority margin of 8.4. Superiority was demonstrated with a 2-sided p=0.0004. The upper bound of the 2-sided 95% confidence interval was -6.26 which is much less than zero. Sensitivity analyses on the assumptions about missing data and the matching included completer’s analyses and analyses that were restricted to the 55 of 61 first stage matches that could be achieved without expanding of the calipers used to identify potential matches. The p-values for non-inferiority in all analyses are <0.0001. Similarly, the p-values for superiority are all ≤ 0.0030. Conclusion: Therefore, we conclude that the Simplify Disc is superior to ACDF control in terms of improvement in NDI and VAS from baseline to Month 12.

The cost-effectiveness of conventional discectomy compared to other surgical techniques for lumbar disk herniation. A systematic review

The cost-effectiveness of conventional discectomy compared to other surgical techniques for lumbar disk herniation. A systematic review

Tubular discectomy versus conventional microdiscectomy for the treatment of lumbar disc herniation: long-term results of a randomised controlled trial

BackgroundThe reference surgical procedure for the treatment of lumbar disc herniation is open microdiscectomy. Minimal invasive discectomy with tubular retractors is hypothesised to cause less tissue damage and result in...

Saving Ligamentum Flavum in One Day Care Microscopic Lumbar Disc Surgery

Background Data Decompression discectomy is a common procedure for treatment of sciatica caused by lumbar disc herniation. Conventional discectomy may damage many important motion segment structures. Microscopic lumbar disc surgery can offer better visualization, magnification and illumination that lead to less invasive disc surgery. Shorter hospital stay, rapid recovery, and decrease the surgical cost is a trend to broaden the types of procedures that can be safely performed as one day care procedure.Purpose: To assess the safety and efficacy of microscopic lumbar discectomy with partial ligamentum flavum preservation in treating L5-S1 lumbar disc herniation as outpatient procedure in one day care hospital.Study design: Prospective clinical case study.Patients and Methods: Between the period of 2012 and 2015 seventy cases were treated for prolapsed L5-S1 disc after failure of conservative treatment. All patients were operated by microscopic lumbar discectomy with partial preservation of the ligamentum flavum as outpatient one day surgery. Visual analogue scale (VAS), Oswestry Disability Index (ODI), and patient satisfaction questionnaire were used to assess the safety and efficacy of our procedure. Preoperative and postoperative MRI was done to confirm ligamentum flavum preservation.Results: At the last follow up, VAS improved from 7.29±0.89 to 1.8±0.93 with P value P<0.002. ODI was improved from 42.01±6.77 to 13.4±4.72 with P value<0.002. One cases had pseudomeningeocele treated conservatively; three patients suffered paresthesia improved with medical conservative treatment. Two patients had limited postoperative superficial infections. Recurrence of lumbar disc herniation was reported in one case 1.5 years after surgery.Conclusion: According to the result, one day microscopic L5-S1 lumbar discectomy with partial ligamentum flavum preservation is possible with favorable clinical outcomes. (2017ESJ132)

Full-Endoscopic Interlaminar Versus Microsurgical Operations in Lumbar Compressive Lesions Surgery: Prospective Randomized Trial of Overall 570 Patients

Introduction: Full-endoscopic operations of lumbar spine are truly minimally invasive surgical procedures and they have become the standard because of their intraoperative and postoperative advantages.Aim: To compare clinical outcomes of full-endoscopic interlaminar technique to conventional microdiscectomy performed during 3 year period.Materials and Methods: A series of 350 patients underwent full-endoscopic interlaminar lumbar discectomy, comparing 220 patients with microdiscectomy and spinal canal decompression, during a 3-year period, is analysed. Oswestry Disability Index (ODI), visual analogue scores (VAS) of back and leg pain were measured preoperatively and at 1, 6, 12, 24 months.Results: All outcome measures improved significantly in both groups (p<0.001). In the full-endoscopic group 88% of the patients no longer had leg pain, and 7% had only occasional pain, postoperatively. In the microdiscectomy (MI) group 78.1% had significant improvement, 13.6% had improvement with occasional pain, and 8% had no improvement. The recurrence rate was 8%. Resection of the herniated disc and sufficient decompression was technically possible in all cases. The overall complication rate (16.4%), and recurrence-reoperation rate (11.8%) was significantly higher in the MI group.Conclusion: The clinical results of the full-endoscopic technique are at least equal to those of the conventional microsurgical discectomy with advantages such as reduced traumatization, improved patient mobility, and lower complication and recurrence rate. With the possibility of selecting the most adequate approach, lumbar disc herniations inside and outside the spinal canal, can be sufficiently removed using the full-endoscopic technique, when taking the appropriate indication criteria into account.

FULL-ENDOSCOPIC LUMBAR DISCECTOMY

ABSTRACT Objective: Retrospective study of the functional outcome of patients with lumbar disc herniation who underwent full-endoscopic discectomy. Methods: Fifteen consecutive patients, 10 men and 5 women, mean age of 34.2 years, were evaluated at 15, 30, 90 and 180 days after surgery through the Oswestry Disability Index (ODI) questionnaire and the Visual Analogue Scale (VAS) of axial and lower limbs pain. Results: There was a significant improvement in ODI evaluation of patients when comparing the preoperative results with the third and sixth postoperative month (p&lt;0.05), as well as the VAS for preoperative axial pain with respect to 15, 30 and 90 days (p&lt;0.05) after surgery, and VAS for preoperative pain in the lower limbs with respect to 15, 90 and 180 days postoperatively (p&lt;0.05). Conclusion: The full-endoscopic discectomy is an effective procedure which should be considered as an alternative to conventional discectomy.

The Significance of Foraminotomy in Lumbar Herniated Disc Surgery

Introduction: Spinal column represents a strong and flexible body axis. It is consisted of vertebrae which are connected by the intervertebral disk and solid fibrous joints. Aim of the Study: To ascertain whether or not and to what extent foraminotomy affects the final outcome of lumbar herniated disc surgery. Patients and Methods: This retrospective study analyzed 71 patients who were operated at the Clinic of Neurosurgery in Banja Luka, in the period from 2009 to 2016. Extirpation of disc was performed in 41 respondents, while in 30 patients, a nerve root was further alleviated, along with the extirpation of disc. All patients were operated under the same conditions. Results: There was no statistically significant difference in the age of women and men who underwent classical discectomy and foraminotomy. There was a statistically significant difference in the disc protrusion and extrusion in patients who underwent conventional discectomy and those who underwent foraminotomy, along with conventional discectomy. There was no statistically significant difference in diagnosis in respondents who underwent conventional discectomy and those who underwent foraminotomy, along with conventional discectomy. There was statistically significant difference in the severity of pain in patients who underwent conventional discectomy and those who underwent foraminotomy, along with conventional discectomy. There was a statistically significant difference in clinical recovery, where the findings were in favor of the respondents who underwent foraminotomy, compared to the respondents who did not. Discussion: The treatment of this syndrome is complex, multidisciplinary and with problematic success, and in cases when the operation is performed, the results are not as good as in the primary operation. Conclusion: The results of this study show that the patients who underwent foraminotomy during the operation of prolapsed lumbar disc have a clinically better result.

A Retrospective Study of Microscope-Assisted Discectomy versus Open Fenestration Discectomy for Lumbar Disc Herniation

Objective: This study aims to research the clinical outcome differences between micro discectomy and open fenestration discectomy in the treatment of lumbar disc herniation. Methods: A retrospective study was carried out in two randomly allocated Groups totaling 467 patients with lumbar disc herniation, the micro discectomy Group A and the conventional discectomy Group B. Patient profiles between the two groups was not significant (P>0.05). JOA scores and modified MacNab criteria were used to evaluate clinical outcomes. Operation time, approach incision length, intra-operative blood loss, hospital stay and total average costs were analyzed. Results: There were statistically significant differences of the indicators such as operative time and bleeding volume etc. in the two groups. There were no position errors and other complications such as nerve root injury, cauda equina injury and infection. No significant difference of JOA score improvement rate or the excellent and good rates was found between the two groups (P>0.05). Conclusion: Both methods can obtain the same satisfactory results of therapy, but the microscope methods have a number of advantages, such as minimal invasion, less blood loss, shorter operation time, shorter hospitalization time and fewer medical expenses etc., which can be one of the ideal minimal invasive operationsA¯Â¼ÂŽ

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

A systematic review. The aim of this study was to compare the effects of sequestrectomy versus conventional microdiscectomy for lumbar disc herniation (LDH). 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. 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. 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). 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. 2.

The Comparison of Sequestrectomy and Conventional Discectomy for the Treatment of a Lumbar Disc Herniation: A Systematic Review

Study Design This is a systematic review. Objective This study aims to compare effects of sequestrectomy versus conventional microdiscectomy for lumbar disc herniation. Summary of Background data Open surgery for LDH can be performed by sequestrectomy or conventional discectomy. Generally, it has been assumed that the former is associated with higher risk of recurrence and less radicular pain and low back pain after surgery. Methods We searched MEDLINE and EMBASE from 1980 to November 2014. We selected randomized controlled trials (RCTs) and prospective studies that compared conventional discectomy versus sequestrectomy for adult patients with LDH and evaluated the following primary outcomes: radicular pain or LBP as measured by a visual analogue scale, neurological deficit of 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 as well as the level of evidence for each study, and we used standard methodological procedures recommended by the Cochrane Collaboration. Results We identified five studies (746 participants) that met our inclusion criteria comparing sequestrectomy versus microdiscectomy. Comparison revealed that with low-quality evidence, there is no significant difference for radicular pain, LBP, functional outcome, complications, and hospital stay for 2 years. In addition, with moderate-quality evidence, there is no significant difference for recurrence rate. Meanwhile, there is very low-quality evidence that analgesic consumption is lower in sequestrectomy than micro/discectomy. Conclusion Both interventions had similar effect on pain after surgery, recurrence rate, functional outcome, and complications; however, sequestrectomy may be superior in terms of postoperative analgesic consumption.

Four-year follow-up results of transforaminal lumbar interbody fusion as revision surgery for recurrent lumbar disc herniation after conventional discectomy

This study investigated the safety, effectiveness, and clinical and radiological outcomes of transforaminal lumbar interbody fusion (TLIF) for recurrent lumbar disc herniation (rLDH) following previous lumbar spine surgery. Seventy-three consecutive patients treated for rLDH between June 2005 and May 2012 were included in the study. The previous surgical procedures included percutaneous discectomy, discectomy with laminotomy, discectomy with unilateral laminectomy, and discectomy with bilateral laminectomy. The level of rLDH was L4–L5 in 51 patients, L5–S1 in 19 patients, and L3–L4 in three patients. All patients underwent reoperation using the TLIF technique. Outcomes were evaluated using the Oswestry disability index (ODI), visual analogue scale (VAS) scores for low back pain and leg pain, and the Japanese Orthopaedic Association (JOA) score, based on the results of physical examinations and questionnaires. The range of motion and disc height index of the operative segment were compared between preoperative and postoperative radiographs. The mean follow-up period was 4.1years. The VAS scores for low back pain and leg pain, ODI, and JOA score improved significantly between the preoperative and final follow-up evaluations. The mean recovery rate of the JOA score was 89.0%. The disc space height and stability at the fused level were significantly improved after surgery. The fusion rate at the final follow-up was 93.2%. There were no major complications. These results indicate that TLIF can be considered an effective, reliable, and safe alternative procedure for the treatment of rLDH.

Does the Fusion of a Lumbar Disk Herniation Improve the Clinical Outcome? An Investigation With a Minimum 10-Year Follow-up

A retrospective long-term (minimum 10 y) follow-up and comparative study. To compare the clinical outcome of surgically treated primary lumbar disk herniation (LDH) by conventional discectomy alone and discectomy with posterolateral fusion without instrumentation. Primary LDH is usually treated by discectomy alone. The long-term outcome of discectomy alone is generally satisfactory. However, the superiority of a discectomy alone in comparison with a discectomy with fusion for primary LDH has yet to be determined. Conventional discectomy without fusion was performed in 39 patients in hospital A (without-fusion group) and conventional discectomy with posterolateral fusion without instrumentation was performed in 109 patients in hospital B (with-fusion group). The subjective symptoms (analgesic use, continuing gait time, 4-grade modified outcome criteria, numerical rating scale of pain and satisfaction with the operation, and the Japanese version of the Roland-Morris Disability Questionnaire) and objective symptoms (straight leg raising test, manual muscle test, and sensory disturbance) were assessed. There were no differences detected in the subjective and objective symptoms between the without-fusion and with-fusion group. Routine fusion surgery for a primary LDH was therefore found to have no apparent benefit even in the long-term outcome.

Reply to the letter to the editor of R. Q. Knight concerning “Does minimally invasive lumbar disc surgery result in less muscle injury than conventional surgery? A randomized controlled trial” by M. Arts, R. Brand, et al. (2011) Eur Spine J 20(1):51–57. doi:10.1007/s00586-012-2491-9

The rational of minimal invasive lumbar disc surgery was less muscle damage, less back pain, shorter hospitalisation, and faster recovery and resumption of daily activities. Based on our study, however, microtubular discectomy (MTD) did neither result in reduced muscle damage and low back pain nor faster speed of recovery compared to the conventional discectomy. In both procedures the nerve root was decompressed with consequent similar relief of radicular leg pain. Interestingly, patients treated with MTD reported higher scores of low back pain during the follow-up period compared to patients treated with conventional discectomy. Therefore, we agree that MTD should not replace conventional discectomy in patients with lumbar disc herniation. Possibly, minimal invasive surgery is superior to conventional open surgery in patients with instrumented spinal fusion, although it should be evaluated in large randomised controlled trials prior to implantation on a large scale.

Recurrence Rate after Herniotomy only versus Discectomy in Lumbar Disc Herniation.

ObjectiveLumbar disc herniation (LDH) recurrence necessitating reoperation can pose problems following spinal surgery, with an overall reported incidence of approximately (3-13%). The purpose of this study is to identify the rate of recurrent disc herniation, to discuss the radiologic indications for herniotomy and to analyze clinical outcomes compared with conventional discectomy.MethodsThis study is a retrospective case control study. The authors retrospectively reviewed 114 patients who underwent herniotomy & conventional discectomy by a single surgeon for single-level LDH between June 2009 and May 2012. Herniotomy group was 57 patients and conventional discectomy group was 57 patients that were selected from 631 patients using stratified randomization. Evaluation for LDH recurrence included detailed medical chart and radiologic review and telephone interview. Postoperative VAS and the Korean version of ODI were examined one week after surgery. Clinical outcome was investigated according to Odom's criteria from three months to three years.ResultsOf the 114 patients for whom the authors were able to definitively assess symptomatic recurrence status, four patients (7%) experienced LDH recurrence following single-level herniotomy and three patients (5.2%) conventional discectomy. There were no differences in the VAS and Korean version of ODI between herniotomy group and conventional discectomy group. The herniotomy group had better results than the conventional discectomy group in clinical outcome from three months to three years, but the difference was not significant.ConclusionThere were no significant differences in clinical outcome between herniotomy and conventional discectomy. Recurrence rates following herniotomy for LDH compare favorably with those in patients who have undergone conventional discectomy, lending further support for its effectiveness in treating herniotomy.