Preliminary Report of Combined Microscopic Fragmentectomy and Nucleoplasty for Sequestrated Lumbar Disc Herniation

OBJECTIVE: This retrospective study was undertaken to evaluate the efficacy of combined microscopic fragmentectomy and intraoperative nucleoplasty for sequestrated lumbar disc herniation. METHODS: Twenty-four patients with magnetic resonance imaging proven sequestrated lumbar disc herniation with small annular leak treated by microscopic fragmentectomy and nucleoplasty were included. Patients were followed for at least one year. The Oswestry Disability Index (ODI; version 2.0) was used to assess preoperative and postoperative functional statuses in three age groups (20-40, 41-60, and >60 years). Visual analog scale and modified MacNab's criteria were used to assess the clinical outcomes for spinal surgery. RESULTS: Mean age at operation was 41.2 years (range 20-72 years). ODIs improved significantly regardless of age group. Significant pain relief was achieved at 1 year after surgery. Most patients (92%) had an excellent or good result according to modified MacNab's criteria, and all patients showed symptomatic improvement after surgery. There were two postoperative wound-related complications, and both responded to antibiotics. No patient underwent further additional surgery because of disc re-herniation during follow-up. CONCLUSION: This study shows that combined microscopic fragmentectomy and intraoperative nucleoplasty without additional discectomy provides a safe operative option for the treatment of sequestrated lumbar disc herniation with small annular leak.