Sequesterectomy versus standard micro‑/open discectomy for lumbar disc herniation: a systematic review and meta-analysis
Clinical Snapshot
PICO Framework
| P — Population | Patients with lumbar disc herniation requiring surgical intervention |
| I — Intervention | Sequesterectomy (removal of herniated disc fragment only) |
| C — Comparator | Standard micro-/open discectomy (removal of herniated disc material plus additional disc tissue) |
| O — Outcomes | Re-herniation rate, complications, operating time, hospital stay, patient-reported outcomes (VAS back pain scores) |
Bottom Line
This meta-analysis of 18 studies involving 4394 patients found no significant difference between sequesterectomy and standard discectomy for lumbar disc herniation in terms of re-herniation rates, complications, or hospital stay. Sequesterectomy demonstrated shorter operative time (mean difference 14.8 minutes) and potentially better long-term back pain outcomes at two years. The evidence suggests sequesterectomy may be a viable alternative to standard discectomy, particularly for appropriate candidates with sequestered disc fragments. However, the lack of quality assessment and heterogeneity evaluation limits confidence in these findings. Clinicians should consider patient-specific factors and surgical expertise when choosing between techniques, as both appear equally safe and effective for preventing re-herniation.
Key Findings
P Value: Re-herniation p=0.769; Complications p=0.077
Effect Size: OR 1.058 for re-herniation, OR 1.399 for complications
Primary Outcome: No significant difference in re-herniation rate between sequesterectomy and discectomy
Nnt Or Sensitivity: Sequesterectomy reduces operating time by mean 14.8 minutes (58.1 vs 72.9 minutes)
Confidence Interval: Re-herniation: 95% CI 0.726-1.541; Complications: 95% CI 0.964-2.032
Clinical Application
Both techniques are established procedures; sequesterectomy may offer shorter operative time without compromising safety Relevant to Australian neurosurgical and orthopaedic spine practice; both procedures covered under Medicare with similar item numbers; choice may depend on surgeon preference and patient factors Patients with lumbar disc herniation suitable for surgical intervention, particularly those with sequestered disc fragments
Abstract
Lumbar disk herniation is a common clinical entity affecting about 1% of the entire population every year. The purpose of the present work is to provide a systematic review and meta-analysis comparing the safety and efficiency of sequesterectomy and discectomy in the management of lumbar disk herniation. A systematic review and meta-analysis using the random effects method was performed. This search was applied through the 6th of March 2025 to PubMed, Scopus, Cochrane Central Register of Controlled Trials and the Directory of Open Access Journals. The data collected included patient demographics, spinal level at which the operation occurred, duration of operation and hospital stay, outcome, recurrence rate as well as potential immediate and delayed complications. A total of 18 original studies with a cumulative number of 4394 patients were identified. No statistically significant difference was found in the re-herniation and complication rate between the two groups (OR: 1.058, 95% CI: 0.726-1.541, p=.769 and OR: 1.399, 95% CI: 0.964-2.032, p=.077 respectively). The same applied for mean hospital stay (standard difference in means: 0.206, SE = 0.167, p= .219). In contrast, mean operating time was found to be significantly shorter in the sequesterectomy group than in the discectomy group (mean 58.086 min versus 72.885 min respectively). As or the patient reported outcomes, VAS score for back pain two years after the operation was the only index that was significantly higher in patients with discectomy (standard difference in means: 0.348, SE = 0.172, p= .04). Based on the available data, the two approaches do not differ in terms of risk of reherniation, reoperation rate and postoperative complications. Nevertheless, patients that have undergone sequesterectomy could potentially benefit from a more significant reduction in back pain in the long run.
References
- 1.Apostolakis, S., Haliasos, N., Stavrinou, L. C., & Stavrinou, P. (2026). Sequesterectomy versus standard micro‑/open discectomy for lumbar disc herniation: a systematic review and meta-analysis. Neurosurgical Review. https://doi.org/10.1186/s13643-022-02048-6
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