Combined Microscopic Sequestrectomy and Intraoperative Low Dose Chemonucleolysis for Sequestrated Lumbar Disc Herniation

Background and Aim: This study was carried out to assess the efficacy of a open microscopic fragmentectomy and intraoperative low dose chemonucleolysis for sequestrated lumbar disc herniation. Methods: The Oswestry Disability Index (ODI) and visual analog scale (VAS) were used to assess the preoperative and 1 year postoperative functional status of 28 patients with magnetic resonance (MR) scan-proven migrated sequestrated lumbar disc herniation treated by microscopic sequestrectomy and intraoperative low dose chemonucleolysis. Follow-up period was for at least 1 year. Results: The mean age at operation was 41.2 years (range 20-72 years). The ODI was improved significantly regardless of age groups. The initial and 1 year post operative VAS score were improved from 8.10 to 1.45. 26 of 28 patients (92%) had excellent / good results, 2 of 28 patients (8%) were fair. There was no patient without improvement of symptom or with worsened symptoms. There were two minor postoperative wound-related complications, which were treated conservatively. No patient underwent further operation because of disc rehemiation. Conclusion: Combined microscopic sequestrectomy and intraoperative low dose chemonucleolysis without discectomy is a safe operative modality for migrated sequestrated lumbar disc herniation.