Poster Presentation 51st International Society for the Study of the Lumbar Spine Annual Meeting 2025

Discectomy vs. sequestrectomy in the treatment of lumbar disc herniation: a systematic review and meta-analysis (#106)

Luca Ambrosio 1 , Elisabetta de Rinaldis 1 , Sathish Muthu 2 , Stipe Corluka 3 , Zorica Buser 4 , Yabin Wu 5 , Hans-Jörg Meisel 6 , Sangwook Yoon 7 , Gianluca Vadala' 1 , Vincenzo Denaro 1 , AO Spine Knowledge Forum Degenerative 5
  1. Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
  2. Government Karur Medical College and Hospital, Karur, India
  3. University Hospital Centre Sestre milosrdnice, Zagreb, Croatia
  4. Gerling Institute, Brooklyn, USA
  5. AO Foundation, Davos, Switzerland
  6. BG Klinikum Bergmannstrost Halle, Halle, Germany
  7. Emory University, Atlanta, USA

Introduction

Lumbar disc herniation (LDH) is a leading cause of low back pain (LBP) and leg pain, often necessitating surgical intervention in cases of persistent symptoms or neurological deficits. Traditional discectomy involves removing the herniated fragment along with additional disc material, which may hasten disc degeneration and contribute to chronic LBP. In contrast, sequestrectomy, which targets only the herniated fragment, might mitigate postoperative LBP but could elevate the risk of LDH recurrence. This study aimed to compare discectomy and sequestrectomy regarding reherniation risk, reoperation rates, complications, pain, patient satisfaction, and perioperative outcomes, including operative time, blood loss, and length of hospital stay (LOS).

 

Methods
A systematic review of the PubMed/MEDLINE and Scopus databases was conducted up to November 30, 2024, adhering to PRISMA guidelines. Both randomized and nonrandomized studies were included. The risk of bias in the included studies was assessed using the RoB-2 and MINORS tools, while evidence quality was evaluated with the GRADE approach. Relevant outcomes were pooled for meta-analysis.

 

Results
Sixteen studies published between 1991 and 2020, encompassing 2009 patients, were included in the analysis (1 randomized controlled trial with 2 follow-up studies, 6 prospective studies, and 7 retrospective studies). No significant differences were observed between discectomy and sequestrectomy regarding reherniation risk (OR: 0.85, 95% CI: 0.57–1.26, p=0.42), reoperation rates (OR: 0.95, 95% CI: 0.64–1.40, p=0.78), or complications (OR: 1.03, 95% CI: 0.50–2.11). Postoperative pain intensity was similar for LBP (MD: -0.06, 95% CI: -0.39–0.28, p=0.74) and leg pain (MD: 0.11, 95% CI: -0.21–0.42, p=0.50). However, sequestrectomy demonstrated superior outcomes at 1 year (leg pain: MD: 0.37, 95% CI: 0.19–0.54) and 2 years (LBP: MD: 0.19, 95% CI: 0.03–0.34, p=0.02; leg pain: MD: 0.20, 95% CI: 0.09–0.31, p=0.0005) (Figures 1 and 2). Additionally, sequestrectomy was associated with higher patient satisfaction (OR: 0.60, 95% CI: 0.40–0.90, p=0.01) and shorter operative time (MD: 8.71 minutes, 95% CI: 1.66–15.75, p=0.02), while blood loss (MD: 0.18, 95% CI: -2.31–2.67, p=0.89) and LOS (MD: 0.02 days, 95% CI: -0.07–0.12, p=0.60) were comparable between procedures.

 

Discussion
Current evidence suggests that discectomy and sequestrectomy yield similar outcomes in terms of reherniation risk, reoperation rates, and complications. Sequestrectomy may offer modest advantages in pain relief, patient satisfaction, and operative time, but the clinical significance of these findings requires confirmation through larger, prospective, randomized studies.

 

Fig. 1. Forest plots of LBP severity in the postoperative period (A), at 1 year (B), and 2 years (C) in patients who underwent discectomy vs. sequestrectomy.

 674b4d4a30ad4-1-s2.0-S152994302401026X-gr4_lrg.jpg

 

Fig. 2. Forest plots of leg pain severity in the postoperative period (A), at 1 year (B), and 2 years (C) in patients who underwent discectomy vs. sequestrectomy.

674b4d4a30ad4-1-s2.0-S152994302401026X-gr5_lrg.jpg