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Subtotal Discectomy Decreases Reoperation Rates

Combined with fragment excision, it is more effective than excision alone

FRIDAY, July 25 (HealthDay News) -- Subtotal discectomy decreases reherniation after lumbar discectomy and is more effective than fragment excision alone, according to an article published in the July issue of the Journal of Spinal Disorders & Techniques.

Glenn D. Wera, M.D., of Case Western Reserve University in Cleveland, and colleagues retrospectively reviewed 259 lumbar discectomies to compare rates of reoperation after annulotomy and subtotal discectomy were performed in addition to excision of disc fragments with rates of reoperation for a series in which only fragment excision was performed. Herniated disks were pathologically classified into four different types using the Carragee classification (type I, fragment/fissure; type II, fragment/defect; type III, fragment/contained; type IV, no fragment/contained).

Of the 259 procedures, 12 required reoperations, the researchers report. The reoperation rate was significantly lower for subtotal discectomy than fragment excision alone in type II disc herniations only (3.4 versus 21.2 percent reoperations). No difference in rates was noted for types I, III or IV disc herniations.

"We attribute the low reherniation rate in our series to the technique of discectomy and curettage of the disc space," the authors write. "In summary, the Carragee system has been rigorously applied to outcomes after fragment excision alone. In these cases, type II herniations (fragment-defect) are especially vulnerable to reherniation and reoperation."

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