Reherniation and failure after lumbar discectomy: a comparison of fragment excision alone versus subtotal discectomy.
METHODS
Retrospective review of 259 lumbar discectomies.


OBJECTIVE
To compare rates of reoperation after subtotal discectomy versus established rates after fragment excision.


BACKGROUND
Herniated nucleus pulposes (HNP) and annular morphology influence rates of reherniation after discectomy. Certain patterns are linked to reherniation rates exceeding 20%.


METHODS
We retrospectively reviewed 259 single-level lumbar discectomies performed between 1980 and 2005. Mean follow-up was 60.9 months. In each case, annulotomy and subtotal discectomy was performed in addition to excision of disc fragments. HNP morphology was classified according to the 4-part system of Carragee (type 1: fragment/fissure; type 2: fragment/defect; type 3: fragment/contained; type 4: no fragment/contained). Fisher exact test was used to compare our proportion of patients with reherniation and/or reoperation to Caragee's series in which only fragment excision was performed.


RESULTS
Of 259 cases, 12 (4.5%) reoperations were performed. A significant difference in failure/reoperation rate was noted in type 2 herniations. There was a significantly lower rate of failure and reoperation for type 2 HNP after subtotal discectomy (3.4%) when compared with fragment excision alone (21.2%), P<0.003.


CONCLUSIONS
Subtotal discectomy is an acceptable technique that decreases reherniation after lumbar discectomy.
Wera
Glenn D
GD
Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH 44106, USA. gwera@yahoo.com
Dean
Clayton L
CL
Ahn
Uri M
UM
Marcus
Randall E
RE
Cassinelli
Ezequiel H
EH
Bohlman
Henry H
HH
Ahn
Nicholas U
NU
D015984:Causality; D017586:Diskectomy / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D007403:Intervertebral Disc / Q000033:anatomy & histology / Q000473:pathology / Q000601:surgery*; D007405:Intervertebral Disc Displacement / Q000145:classification / Q000473:pathology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013525:Surgical Instruments / Q000009:adverse effects / Q000592:standards; D017211:Treatment Failure