PainSci commentary on Barth 2008: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.
Barth et al. reported on the status of of a few dozen patients two years after having one of two similar surgical procedures for their disc herniations, either microdiscectomy or microscopic sequestrectomy. Their most surprising finding was that many patients still had clear signs of herniation … but many of those patients no longer had symptoms. More to the point of their research, they found that sequestrectomy “less postoperative disc degeneration than standard microdiscectomy.”
~ Paul Ingraham
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
STUDY DESIGN: Single-center randomized prospective study at a university hospital.
OBJECTIVE: The aim of the present study was to assess disc morphology radiologically 2 years after surgery in a cohort of prospectively randomized patients undergoing microdiscectomy (D) or microscopic sequestrectomy (S) to compare the results and to correlate this data with clinical outcome.
SUMMARY OF BACKGROUND DATA: Simple fragment excision in cases of herniated lumbar discs has been repeatedly reported as an alternative to standard microdiscectomy, and according to the literature clinical results of both techniques seem to be comparable. As sequestrectomy, however, avoids any additional damage to the disc, the fate of the intervertebral space over time may well differ between the 2 procedures and may potentially even have an impact on outcome. Respective postoperative radiological data are not available so far.
MATERIAL AND METHODS: This radiological evaluation represents a 2-year follow-up study by magnetic resonance imaging of a previously reported cohort of 84 patients harboring lumbar disc herniations that were randomized to D and S in equal parts. Disc and nondisc characteristics such as disc desiccation, loss of disc height, and endplate changes plus form, size, and location of canal-compromising disc lesions were assessed by a blinded neuroradiologist. Pre- and postoperative radiological data were compared and correlated with clinical outcome.
RESULTS: There was a high incidence of relevant (>or=4 mm) postoperative protrusions/extrusions of 66% in group D and 68% in group S (NS). The presence of a protrusion/extrusion, however, did not correlate with low back pain or sciatica. Loss of disc height over time was more common in group D (63%) than in group S (38%; P < 0.05) and endplate degeneration also increased significantly more in group D (47 vs. 14% in group S; P < 0.01). A significant correlation was present between Modic type endplate changes and low back pain.
CONCLUSION: Nondiscal pathologies, in particular Modic type endplate changes, seem to play an important role in the etiology of unfavorable clinical outcome after surgery for disc herniations. Sequestrectomy demonstrated significantly less postoperative disc degeneration than standard microdiscectomy after 2 years and may thus represent an attractive treatment alternative.
- “Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta-Analysis,” Zhong et al, Pain Physician, 2017.
- “Resolution of Lumbar Disk Herniation without Surgery,” Jennifer Hong and Perry A Ball, NEJM.org.
- “Progression of lumbar disc herniations over an eight-year period in a group of adult Danes from the general population: a longitudinal MRI study using quantitative measures,” Kjaer et al, BMC Musculoskeletal Disorders, 2016.
- “Magnetic resonance imaging in follow-up assessment of sciatica,” Barzouhi et al, New England Journal of Medicine, 2013.
- “Magnetic resonance imaging findings 10 years after treatment for lumbar disc herniation,” Fraser et al, Spine (Phila Pa 1976), 1995.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Inciting events associated with lumbar disc herniation. Suri 2010 Spine J.
- Prediction of an extruded fragment in lumbar disc patients from clinical presentations. Pople 1994 Spine (Phila Pa 1976).
- Characteristics of patients with low back and leg pain seeking treatment in primary care: baseline results from the ATLAS cohort study. Konstantinou 2015 BMC Musculoskelet Disord.
- Effectiveness and cost-effectiveness of universal school-based mindfulness training compared with normal school provision in reducing risk of mental health problems and promoting well-being in adolescence: the MYRIAD cluster randomised controlled trial. Kuyken 2022 Evid Based Ment Health.
- Is there a relationship between throbbing pain and arterial pulsations? Mirza 2012 J Neurosci.