Ambrosio Luca, Vadalà Gianluca, de Rinaldis Elisabetta, Muthu Sathish, Ćorluka Stipe, Buser Zorica, Meisel Hans-Jörg, Yoon S Tim, Denaro Vincenzo
Research Unit of Orthopaedic and Trauma Surgery, Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Rome, Italy; Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
Research Unit of Orthopaedic and Trauma Surgery, Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Rome, Italy; Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
Spine J. 2025 Feb;25(2):211-226. doi: 10.1016/j.spinee.2024.09.007. Epub 2024 Sep 26.
Lumbar disc herniation (LDH) is a leading cause of low back pain (LBP) and leg pain and may require surgical treatment in case of persistent pain and/or neurological deficits. Conventional discectomy involves removing the herniated fragment and additional material from the disc space, potentially accelerating disc degeneration and contributing to chronic LBP. Conversely, by resecting the herniated fragment only, sequestrectomy may reduce postoperative LBP while increasing the risk of LDH recurrence.
To compare discectomy versus sequestrectomy in terms of risk of reherniation, reoperation rate, complications, pain, satisfaction, and perioperative outcomes (operative time, blood loss, length of stay [LOS]).
Systematic review and meta-analysis.
A systematic search of PubMed/MEDLINE and Scopus databases was performed through May 1, 2024 for both randomized and nonrandomized studies. The search was conducted according to PRISMA guidelines. The RoB-2 and MINORS tools were utilized to assess the risk of bias in included studies. The quality of the evidence was evaluated according to the GRADE approach. Relevant outcomes were pooled for meta-analysis.
A total of 16 articles (1 randomized controlled trial with 2 follow-up studies, 6 prospective studies, and 7 retrospective studies) published between 1991 and 2020 involving 2009 patients were included for analysis. No significant differences were noted between discectomy versus sequestrectomy in terms of risk of reherniation (OR: 0.85, 95% CI: 0.57 to 1.26, p=.42), reoperation rate (OR: 0.95, 95% CI: 0.64 to 1.40, p=.78), and complications (OR: 1.03, 95% CI: 0.50 to 2.11, p=.94). Although LBP (MD: -0.06, 95% CI: -0.39 to 0.28, p=.74) and leg pain intensity (MD: 0.11, 95% CI: -0.21 to 0.42, p=.50) were similar postoperatively, significantly better outcomes were reported by patients treated with sequestrectomy at 1 year (leg pain: MD: 0.37, 95% CI: 0.19 to 0.54, p<.0001) and 2 years (LBP: MD: 0.19, 95% CI: 0.03 to 0.34, p=.02; leg pain: MD: 0.20, 95% CI: 0.09 to 0.31, p=.0005). Sequestrectomy also resulted in a higher patient satisfaction (OR: 0.60, 95% CI: 0.40 to 0.90, p=.01) and shorter operative time (MD: 8.71, 95% CI: 1.66 to 15.75, p=.02), while blood loss (MD: 0.18, 95% CI: -2.31 to 2.67, p=.89) and LOS (MD: 0.02 days, 95% CI: -0.07 to 0.12, p=.60) did not significantly differ compared to discectomy.
Based on the current evidence, discectomy and sequestrectomy do not significantly differ in terms of risk of reherniation, reoperation rate, and postoperative complications. Patients treated with sequestrectomy may benefit from a marginally higher pain improvement, better satisfaction outcomes, and a shorter operative time, although the clinical relevance of these differences needs to be validated in larger, prospective, randomized studies.
腰椎间盘突出症（LDH）是导致腰痛（LBP）和腿痛的主要原因，若出现持续性疼痛和/或神经功能缺损，可能需要手术治疗。传统椎间盘切除术需要切除突出的碎片以及椎间盘间隙中的其他组织，这可能会加速椎间盘退变并导致慢性腰痛。相反，髓核摘除术仅切除突出的碎片，可能会降低术后腰痛，但会增加LDH复发的风险。
比较椎间盘切除术和髓核摘除术在再突出风险、再次手术率、并发症、疼痛、满意度及围手术期结局（手术时间、失血量、住院时间[LOS]）方面的差异。
系统评价和荟萃分析。
截至2024年5月1日，对PubMed/MEDLINE和Scopus数据库进行系统检索，纳入随机和非随机研究。检索按照PRISMA指南进行。使用RoB-2和MINORS工具评估纳入研究的偏倚风险。根据GRADE方法评估证据质量。对相关结局进行荟萃分析。
共纳入1991年至2020年发表的16篇文章（1项随机对照试验及2项随访研究、6项前瞻性研究和7项回顾性研究），涉及2009例患者进行分析。椎间盘切除术和髓核摘除术在再突出风险（OR：0.85，95%CI：0.57至1.26，p = 0.42）、再次手术率（OR：0.95，95%CI：0.64至1.40，p = 0.78）和并发症（OR：1.03，95%CI：0.50至2.11，p = 0.94）方面无显著差异。虽然术后腰痛（MD：-0.06，95%CI：-0.39至0.28，p = 0.74）和腿痛强度（MD：0.11，95%CI：-0.21至0.42，p = 0.50）相似，但髓核摘除术治疗的患者在1年时（腿痛：MD：0.37，95%CI：0.19至0.54，p < 0.0001）和2年时（腰痛：MD：0.19，95%CI：0.03至0.34，p = 0.02；腿痛：MD：0.20，95%CI：0.09至0.31，p = 0.0005）报告的结局明显更好。髓核摘除术还导致患者满意度更高（OR：0.60，95%CI：0.40至0.90，p = 0.01）和手术时间更短（MD：8.71，95%CI：1.66至15.75，p = 0.02），而与椎间盘切除术相比，失血量（MD：0.18，95%CI：-2.31至2.67，p = 0.89）和住院时间（MD：0.02天，95%CI：-0.07至0.12，p = 0.60）无显著差异。
基于现有证据，椎间盘切除术和髓核摘除术在再突出风险、再次手术率和术后并发症方面无显著差异。接受髓核摘除术治疗的患者可能会从稍高的疼痛改善、更好的满意度结局和更短的手术时间中获益，尽管这些差异的临床相关性需要在更大规模的前瞻性随机研究中得到验证。
