title: Long-term outcome of 104 patients after lumbar sequestrectomy according to Williams.
abstract: OBJECTIVE
  The authors report the late outcome of 104 consecutive patients after Williams' sequestrectomy for virgin lumbar disc herniation.
  
  
  METHODS
  The clinical records and the mailed questionnaires of 38 women and 66 men operated consecutively between March 1991 and November 1993 were analyzed retrospectively. In these 104 patients, 105 Williams' sequestrectomies were performed.
  
  
  RESULTS
  The mean age at operation was 50.5 years (range, 23.2-86.7 yr), and follow-up ranged from 4.1 to 6.9 years (mean, 5.3 yr). Success rates, including excellent, good, and fair results, were 92.5%, 94.7%, and 93.3% for lumbalgia, radicular pain, and neurological dysfunction, respectively. Only a few patients did not improve or presented with worsened symptoms. Three of four patients with cauda equina syndrome recovered immediately after the intervention. There were eight (7.7%) minor postoperative complications, which were treated conservatively. Three women and three men (5.8%) underwent a revision procedure for a recurrent lumbar disc herniation at the same level after 0.4 to 3.1 years (mean, 1.8 yr). Two (1.9%) of these patients underwent further operations because of reherniation, and they required internal instrumentation eventually because of failed back surgery syndrome.
  
  
  CONCLUSIONS
  Williams' conservative approach with sequestrectomy alone is a safe operative modality. It should be used whenever possible. As demonstrated in our series with a long follow-up time, the results are as favorable as or better than results after standard microsurgical lumbar discectomy with curettement of the interspace. Whether the incidence of failed back surgery syndrome can be reduced by this approach remains to be proved.
authors.affiliation: Department of Neurosurgery, University of Berne, Inselspital, Switzerland. Aertze.Beau-Site@hirslanden.ch
authors.forename: M
authors.initials: M
authors.lastname: Wenger
authors.forename: L
authors.initials: L
authors.lastname: Mariani
authors.forename: A
authors.initials: A
authors.lastname: Kalbarczyk
authors.forename: U
authors.initials: U
authors.lastname: Gröger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000601:surgery*; D017116:Low Back Pain / Q000209:etiology; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology; D019635:Neurosurgical Procedures / Q000009:adverse effects; D010146:Pain / Q000209:etiology; D011128:Polyradiculopathy / Q000601:surgery; D011843:Radiculopathy / Q000209:etiology; D012008:Recurrence; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome