453 - The Effect of Open Microdiscectomy (Sequestrectomy) with Percutaneous...

#453 The Effect of Open Microdiscectomy (Sequestrectomy) with Percutaneous Endoscopic Lumbar Discectomy (PELD) for Lumbar Disc: The Effect of Anular Preservation

Lumbar Therapies and Outcomes

Poster Presented by: J. Chung


J.H. Chung (1)
C.K. Park (1)
J.H. Hwang (1)

(1) The Leon Wiltse Memorial Hospital, Neursurgery, Suwon, Korea, Republic of


Purpose: Large anular incision and defects found at posterior lumbar discectomy have been associated with more frequent reherniation when removed only extruded or loose intervertebral fragments. The more aggressive removal of remaining intervertebral disc material may decrease the risk of reherniation, but the overall outcome was less satisfactory (i.e., postoperative back pain). This study evaluated that operative technique with anular preservation plays a role in postoperatively more decreased back pain and lower recurrent rate than open microdiscectomy.

Materials and Methods: Medical records were retrospectively reviewed and phone call survey were undertaken for 32 patients (MD-PELD group) who had under gone open microdiscectomy (extraanular sequestrectomy) with PELD (intraanular discectomy) and 46 patients (MD group) who had under gone open microdiscectomy with straight slit incision through the annulus for lumbar disc herniation with disc grade 2 to 6(among modified Pfirrmann grading system grade 1 to 8) between June 2009 and May 2011. Preoperative, postoperative 7th day, and postoperatively recent VAS score were checked, and the effect and recurrent rate of operative techniques according to disc degeneration grades were also evaluated.

Results: Improvement of pain (preoperative VAS score - POD 7th days VAS score, and preoperative VAS score - recent VAS score) of both two groups were not different among lumbar disc herniation with disc degeneration grade 2 to 6. But, improvement of pain of MD-PELD group was significantly higher (p-value 0.033) and immediate postoperative (POD 7th) VAS score of MD-PELD group was more significantly higher(p-value 0.041) than MD group for lumbar disc herniation with disc degeneration grade 2 to 5(exclusion of grade 6). Recurrent rates of MD-PELD group (9.4%) and MD group (10.9%) were not different statistically. But patients with reherniation of MD-PELD groups were controlled with epidural block for pain control unlikely 80% among reherniation patients of MD group had a reoperation. Other factors did not affect recurrent rate and pain improvement.

Conclusion: MD-PELD with anular preservation showed satisfactory results that were comparable with those of open microdiscectomy with anular incision. Based on the results of this study, MD-PELD with anular preservation can be recommended for the management of lumbar disc herniation within disc degeneration grade 2 to 5.