HERNIECTOMY WITHOUT DISCECTOMY IN EXTRUDED LUMBAR DISC HERNIATION; SHOULD IT BE THE GOLD STANDARD?

Özet

Objective: Microdiscectomy in lumbar disc herniation (LDH) is the gold standard treatment, but conventional discectomy is still the most widely used across the world. This study aimed to evaluate the treatment outcomes of herniectomy compared to conventional discectomy for an extruded lumbar disc. Materials and Methods: A total of 788 patients were included in the study. Of this population, 548 were males and 240 were females. This was a retrospective study that was conducted from 2009 to 2018. Conventional discectomy and herniectomy for the treatment of extruded LDH were compared. Minimum follow-up period was 2 years. Results: Most of the patients were pain-free in both procedures (herniectomy and conventional discectomy). The surgical outcome of herniectomy did not significantly differ by age, gender, educational background, preoperative VAS for back, preoperative VAS for radicular pain, Oswestry disability index score, return to the previous job and level of herniation in comparison to conventional microdiscectomy. Conclusion: Herniectomy in extruded lumbar disc prolapse is similar compared to conventional discectomy in terms of pain removal and recurrent disc prolapse. Furthermore, removal of only the herniated disc preserves the disc height, which has many advantages including functional mobility and no alteration in the diameter of the intervertebral foramen. Also, a decrease in the incidence of adjacent level disc prolapse may be due to low stress in relation to conventional discectomy. It is still not clear whether the herniectomy in extruded lumbar disc surgery should be a gold standard or not.