• Glenn D Wera, Clayton L Dean, Uri M Ahn, Randall E Marcus, Ezequiel H Cassinelli, Henry H Bohlman, and Nicholas U Ahn.
• Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH 44106, USA. gwera@yahoo.com
• J Spinal Disord Tech. 2008 Jul 1; 21 (5): 316-9.

Study DesignRetrospective review of 259 lumbar discectomies.ObjectiveTo compare rates of reoperation after subtotal discectomy versus established rates after fragment excision.Summary Of Background DataHerniated nucleus pulposes (HNP) and annular morphology influence rates of reherniation after discectomy. Certain patterns are linked to reherniation rates exceeding 20%.MethodsWe retrospectively reviewed 259 single-level lumbar discectomies performed between 1980 and 2005. Mean follow-up was 60.9 months. In each case, annulotomy and subtotal discectomy was performed in addition to excision of disc fragments. HNP morphology was classified according to the 4-part system of Carragee (type 1: fragment/fissure; type 2: fragment/defect; type 3: fragment/contained; type 4: no fragment/contained). Fisher exact test was used to compare our proportion of patients with reherniation and/or reoperation to Caragee's series in which only fragment excision was performed.ResultsOf 259 cases, 12 (4.5%) reoperations were performed. A significant difference in failure/reoperation rate was noted in type 2 herniations. There was a significantly lower rate of failure and reoperation for type 2 HNP after subtotal discectomy (3.4%) when compared with fragment excision alone (21.2%), P<0.003.ConclusionsSubtotal discectomy is an acceptable technique that decreases reherniation after lumbar discectomy.

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