title: A novel surgical treatment of lumbar disc herniation in patients with long-standing degenerative disc disease.
abstract: OBJECTIVE
  In patients with long-standing lumbar degenerative disc disease (DDD) conventional surgical therapy of a herniated disc may worsen back pain due to further destabilization of the affected motion segment. In recent years, total-disc arthroplasty has been introduced to treat DDD while maintaining segmental mobility. To the best of the authors' knowledge, this is the first report involving lumbar disc herniation and long-standing DDD submitted to combined anterior microdiscectomy with sequestrectomy and total-disc arthroplasty.
  
  
  METHODS
  Fourteen patients with long-standing DDD and a recently herniated disc underwent total anterior lumbar microdiscectomy, with removal of the herniated disc, and total-disc arthroplasty. There were nine women and five men whose mean age was 39.6 years (range 22-56 years) in whom back and leg pain had been present for a mean of 75.4 (range 9-360) and 9.4 (range 0.33-36) months, respectively. Thirteen patients underwent L5-S1 and one underwent L4-5 surgery. In all cases the procedure and the postoperative courses were uneventful. After a mean follow-up period of 12.5 months (range 3.9-21.1 months), outcome was excellent in 11 and good in three patients.
  
  
  CONCLUSIONS
  The aforementioned surgical treatment of a recently herniated lumbar disc in patients with long-standing DDD yielded very favorable early results.
authors.affiliation: Department of Neurosurgery, The Hirslanden Group, Klinik Beau-Site, Bern, Switzerland.
authors.forename: Markus
authors.initials: M
authors.lastname: Wenger
authors.forename: Thomas-Marc
authors.initials: TM
authors.lastname: Markwalder
mesh_terms: D000328:Adult; D001178:Arthroplasty / Q000379:methods*; D002908:Chronic Disease; D017586:Diskectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D016896:Treatment Outcome