title: Two-year outcome after lumbar microdiscectomy versus microscopic sequestrectomy: part 1: evaluation of clinical outcome.
abstract: METHODS
  Single-center randomized prospective study at a university hospital.
  
  
  OBJECTIVE
  The aim of the present study was to provide a 2-year outcome comparison of microdiscectomy (D) versus microscopic sequestrectomy (S) in terms of reherniation rates, clinical investigation, and self-rated parameters using a comprehensive questionnaire.
  
  
  BACKGROUND
  Simple fragment excision in cases of herniated lumbar discs has been repeatedly reported as an alternative to standard microdiscectomy, but prospective data with sufficient follow-up is lacking to date. Preliminary results of a prospective randomized study in patients with lumbar disc herniations indicated equal reherniation rates and a trend toward superior clinical results in patients undergoing only sequestrectomy after 4 to 6 months.
  
  
  METHODS
  Eighty-four patients with lumbar disc herniations were treated with microdiscectomy or microscopic sequestrectomy in equal parts. Patients were re-evaluated thoroughly clinically after 2 years. Results of this investigation (low back pain, sciatica, motor-, sensory-, reflex-, straight leg raising test-indexes) and self-rated parameters including SF-36 were analyzed for differences between groups and between time points.
  
  
  RESULTS
  Thirty-eight (D) and 40 (S) patients were attainable for follow-up. Reherniation rates did not differ significantly (10.5%, group D; 12.5%, group S; P = 1.0). Following dramatic improvement after surgery in both groups, results of the clinical investigation remained stable over time without significant differences between groups. In contrast, self-rated assessment demonstrated clinical deterioration of the surgical results within the first 2 years after microdiscectomy, while they rather improved after sequestrectomy. Because of this development, the outcome measures at 2 years pointed in favor of sequestrectomy with results being significant for important parameters such as use of analgesics, performance, and overall outcome.
  
  
  CONCLUSIONS
  Reherniation rates within 2 years after sequestrectomy and microdiscectomy are comparable. However, outcome after microdiscectomy seems to worsen over time, whereas it remains stable after sequestrectomy. Thus, 2-year follow-up revealed clinical results favoring sequestrectomy. Performing sequestrectomy alone may therefore represent an advantageous alternative to standard microdiscectomy.
authors.affiliation: Department of Neurosurgery, University Hospital Mannheim, Medical Faculty Mannheim of the Ruprecht-Karls-University of Heidelberg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Barth
authors.forename: Christel
authors.initials: C
authors.lastname: Weiss
authors.forename: Claudius
authors.initials: C
authors.lastname: Thomé
mesh_terms: D000328:Adult; D017586:Diskectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008159:Lumbar Vertebrae; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012008:Recurrence; D011795:Surveys and Questionnaires; D016896:Treatment Outcome