Introduction: Lumbar disc herniation(LDH) recurrence necessitating reoperation can pose problems following spinal surgery, with an overall reported incidence of approximately (3–13%). The purpose of this study is to identify the rate of recurrence disc herniation, to discuss the radiologic indications for herniotomy and to analyze clinical outcomes compared with conventional discectomy

Methods: The authors retrospectively reviewed 114 patients who underwent herniotomy & conventional discectomy by a single surgeon for single-level LDH between June 2009 and May 2012. Evaluation for LDH recurrence included detailed medical chart and radiologic review and telephone interview. Postoperative VAS and the Korean version of ODI were examined one week after surgery. Clinical outcome was investigated following Odom's criteria from three months to three years.

Results: Of the 57 patients for whom the authors were able to definitively assess symptomatic recurrence status, four patients (7%) experienced LDH recurrence following single-level herniotomy and three patients (5.2%) conventional discectomy. Postoperative VAS decreased more following conventional discectomy than herniotomy, but the difference was not significant. There were no differences in the Korean version of ODI between herniotomy group and conventional discectomy group. The herniotomy group had better results than the conventional discectomy group in clinical outcome from three months to three years, but the difference was not significant.

Conclusions: There were no significant differences in clinical outcome between herniotomy and conventional discectomy. Recurrence rates following herniotomy for LDH compare favorably with those in patients who have undergone conventional discectomy, lending further support for its effectiveness in treating herniotomy.

Patient Care: We carry out herniotomy in patient that had free fragment, low continuity with disc space and minimal disc protursion of parent disc on MR. So postoperative back pain and operating time can be decreased.

Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe effectiveness of herniotomy 2) Identify proper treatment in lumbar disc herniation.

References: 1. Yasargil M. Microsurgical operation of herniated lumbar disc. Lumbar Disc Adult Hydrocephalus: Springer; 1977:81-81. 2. Caspar W, Campbell B, Barbier DD, Kretschmmer R, Gotfried Y. The Caspar microsurgical discectomy and comparison with a conventional standard lumbar disc procedure. Neurosurgery. Jan 1991;28(1):78-86; discussion 86-77. 3. Williams RW. Microlumbar discectomy: a conservative surgical approach to the virgin herniated lumbar disc. Spine. Jun 1978;3(2):175-182. 4. Faulhauer K, Manicke C. Fragment excision versus conventional disc removal in the microsurgical treatment of herniated lumbar disc. Acta neurochirurgica. 1995;133(3-4):107-111. 5. Striffeler H, Groger U, Reulen HJ. "Standard" microsurgical lumbar discectomy vs. "conservative" microsurgical discectomy. A preliminary study. Acta neurochirurgica. 1991;112(1-2):62-64. 6. Wenger M, Mariani L, Kalbarczyk A, Groger U. Long-term outcome of 104 patients after lumbar sequestrectomy according to Williams. Neurosurgery. Aug 2001;49(2):329-334; discussion 334-325. 7. Moliterno JA, Knopman J, Parikh K, et al. Results and risk factors for recurrence following single-level tubular lumbar microdiscectomy: Clinical article. Journal of Neurosurgery: Spine. 2010;12(6):680-686. 8. Faldini C, Leonetti D, Nanni M, et al. Cervical disc herniation and cervical spondylosis surgically treated by Cloward procedure: a 10-year-minimum follow-up study. Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology. Jun 2010;11(2):99-103. 9. Caspar W. A new surgical procedure for lumbar disc herniation causing less tissue damage through a microsurgical approach. Lumbar Disc Adult Hydrocephalus: Springer; 1977:74-80. 10. Hudgins R. Experience with limited versus extensive disc removal in patients undergoing microsurgical operations for ruptured lumbar discs (comment). Neurosurgery. 1988;22(1):85. 11. McCulloch JA. Focus issue on lumbar disc herniation: macro- and microdiscectomy. Spine. Dec 15 1996;21(24 Suppl):45S-56S. 12. Davis RA. A long-term outcome analysis of 984 surgically treated herniated lumbar discs. Journal of neurosurgery. Mar 1994;80(3):415-421. 13. Cinotti C, Postacchini F. Lumbar disc herniation. In: Postacchini F, ed: Springer Verlag Wien; 1999. 14. Kirkaldy-Willis WH, Wedge JH, Yong-Hing K, Reilly J. Pathology and pathogenesis of lumbar spondylosis and stenosis. Spine. Dec 1978;3(4):319-328. 15. Balderston RA, Gilyard GG, Jones AA, et al. The treatment of lumbar disc herniation: simple fragment excision versus disc space curettage. Journal of spinal disorders. Mar 1991;4(1):22-25. 16. Mochida J, Nishimura K, Nomura T, Toh E, Chiba M. The importance of preserving disc structure in surgical approaches to lumbar disc herniation. Spine. Jul 1 1996;21(13):1556-1563; discussion 1563-1554. 17. Williams RW. Microlumbar discectomy. A 12-year statistical review. Spine. Oct 1986;11(8):851-852. 18. Rogers LA. Experience with limited versus extensive disc removal in patients undergoing microsurgical operations for ruptured lumbar discs. Neurosurgery. Jan 1988;22(1 Pt 1):82-85. 19. Fruhwirth J, Koch G, Amann W, Hauser H, Flaschka G. Vascular complications of lumbar disc surgery. Acta neurochirurgica. 1996;138(8):912-916.