This article is more than 5 years old. Information may no longer be current.

Lower reoperation rate with subtotal discectomy vs. fragment extraction alone

Calcification in reherniated discs has led researchers to suggest an additional lumbar classification type.

Add topic to email alerts

Receive an email when new articles are posted on

Please provide your email address to receive an email when new articles are posted on .

Subscribe

Added to email alerts

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

Back to Healio

We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.

Back to Healio

SAN DIEGO — Subtotal discectomy may lead to significantly lower lumbar spine reherniation rates compared to fragment excision alone, according to a study presented here.

In a retrospective review of 259 single-level lumbar procedures, Glenn Wera, MD, and colleagues found a 3.4% reoperation rate for type-2 Carragee-classified herniated nucleus pulposes (HNP) treated with subtotal discectomy. In contrast, published reports have found a 21.2% reoperation rate using fragment excision alone.

“We contribute our low reherniation rates to our surgical technique,” said Wera, who presented the study results at the American Academy of Orthopaedic Surgeons annual meeting.

The researchers also found that two reherniated discs in their study were calcified — a classification not covered with the Carragee system. In addition, they discovered that a number of patients referred for reherniation also had calcification. Such discs could potentially have a significant risk for reherniation, Wera noted.

“Lumbar disc reherniation is significantly lower after subtotal discectomy compared to published rates after fragment excision,” he said.

“Surgeons should consider a subtotal discectomy for Carragee class 2 defects, characterized by a large annul defect and free fragment. If performed in all [cases], subtotal lumbar discectomy has a low rate of reoperation. We’d also like to introduce the concept of the class 5 for calcified lumbar [discs],” Wera said.

The researchers reviewed single-level lumbar cases with HNP. Surgeons performed subtotal discectomy with an annulotomy and free-fragment removal. The patients had a mean follow-up of 60.9 months. The researchers categorized the cases using the Carragee classification and determined reoperation rates. They compared their findings to results published by Eugene J. Carragee, MD, using fragment extraction alone. Wera and his colleagues discovered an overall 4.5% reoperation rate for the study group and found a significant reduction and reoperation rate for type-2 HNP.

For more information:

• Wera G, Dean C, Ahn U, et al. A comparison of fragment excision versus subtotal discectomy. #212. Presented at the American Academy of Orthopaedic Surgeons 74th Annual Meeting. Feb. 14-18, 2007. San Diego.