Surgery of lumbar disc herniation is still a problem since Mixter and Barr. Main trouble is dissatisfaction after the operation. Today there is a debate on surgical or conservative treatment despite spending great effort to provide patients with satisfaction. The main problem is segmental instability, and the minimally invasive approach via microscope or endoscope is not necessarily appropriate solution for all cases. Microsurgery or endoscopy would be appropriate for the treatment of Carragee type I and type III herniations. On the other hand in Carragee type II and type IV herniations that are prone to develop recurrent disc herniation and segmental instability, the minimal invasive techniques might be insufficient to achieve satisfactory results. The posterior transpedicular dynamic stabilization method might be a good solution to prevent or diminish the recurrent disc herniation and development of segmental instability. In this study we present our experience in the surgical treatment of disc herniations. 1. Introduction The surgical treatment of lumbar disc herniation is performed when the conservative treatment is recalcitrant and only ten percent of all lumbar disc herniations cases are candidates to surgery . The main problem with the surgery is that the lumbar pain of the patients does not necessarily relieved following surgery and even they might become worse. For this reason, there are serious anxiety and suspicion against the surgical treatment of lumbar disc herniations. This phenomenon is also valid for some spine surgeons who will perform the operation. Even on their own series of Mixter and Barr, who first performed the discectomy of lumbar disc herniations, the success and failure rates compete head to head . Later Caspar and Yasargil introduced the microscope into the disc surgery and allowed minimal anatomic damage; however, no significant rise was achieved in satisfactory results [3, 4]. Carragee et al. revealed that the occurrence of disc herniation, the type of surgery, and the rates of reherniation are in a close relation with the defect on posterior annulus . Lumbar disc herniation is not a separate illness but a part of a degenerative process, so the treatment should be designed in this manner. It is known that if the defect on the annulus is small, annulus has capacity to repair itself after fragmentectomy with both operative techniques: endoscopy and microdiscectomy. On the other hand, if the defect is large, problem arises at that time [6, 7]. In this paper, we discussed our results in the light of literature. We
S. S. Hu, “Lumbar disc herniation section of disorders, diseases, and injuries of the spine,” in Current Diagnosis and Treatment in Orthopedics, H. B. Skinner, Ed., pp. 246–249, McGraw-Hill, New York, NY, USA, 4th edition, 2006.
E. J. Carragee, M. Y. Han, P. W. Suen, and D. Kim, “Clinical outcomes after lumbar discectomy for sciatica: the effects of fragment type and anular competence,” Journal of Bone and Joint Surgery A, vol. 85, no. 1, pp. 102–108, 2003.
G. D. Wera, C. L. Dean, U. M. Ahn et al., “Reherniation and failure after lumbar discectomy: a comparison of fragment excision alone versus subtotal discectomy,” Journal of Spinal Disorders and Techniques, vol. 21, no. 5, pp. 316–319, 2008.
E. J. Carragee, A. O. Spinnickie, T. F. Alamin, and S. Paragioudakis, “A prospective controlled study of limited Versus subtotal posterior discectomy: short-term outcomes in patients with herniated lumbar intervertebral discs and large posterior anular defect,” Spine, vol. 31, no. 6, pp. 653–657, 2006.
Y. Katayama, Y. Matsuyama, H. Yoshihara et al., “Comparison of surgical outcomes between macro discectomy and micro discectomy for lumbar disc herniation: a prospective randomized study with surgery performed by the same spine surgeon,” Journal of Spinal Disorders and Techniques, vol. 19, no. 5, pp. 344–347, 2006.
A. F. Ozer, T. Oktenoglu, M. Sasani et al., “Preserving the ligamentum flavum in lumbar discectomy: a new technique that prevents scar tissue formation in the first 6 months postsurgery,” Neurosurgery, vol. 59, supplement 1, pp. S126–S133, 2006.
J. Brotchi, B. Pirotte, O. De Witte, and M. Levivier, “Prevention of epidural fibrosis in a prospective series of 100 primary lumbo-sacral discectomy patients: follow-up and assessment at re-operation,” Neurological Research, vol. 21, supplement 1, pp. S47–S50, 1999.
C. Thomé, M. Barth, J. Scharf, and P. Schmiedek, “Outcome after lumbar sequestrectomy compared with microdiscectomy: a prospective randomized study,” Journal of Neurosurgery, vol. 2, no. 3, pp. 271–278, 2005.
E. Yorimitsu, K. Chiba, Y. Toyama, and K. Hirabayashi, “Long-term outcomes of standard discectomy for lumbar disc herniation: a follow-up study of more than 10 years,” Spine, vol. 26, no. 6, pp. 652–657, 2001.
A. Fujiwara, K. Tamai, M. Yamato et al., “The relationship between facet joint osteoarthritis and disc degeneration of the lumbar spine: an MRI study,” European Spine Journal, vol. 8, no. 5, pp. 396–401, 1999.
C. A. Niosi, Q. A. Zhu, D. C. Wilson, O. Keynan, D. R. Wilson, and T. R. Oxland, “Biomechanical characterization of the three-dimensional kinematic behaviour of the Dynesys dynamic stabilization system: an in vitro study,” European Spine Journal, vol. 15, no. 6, pp. 913–922, 2006.
A. Rohlmann, T. Zander, H. Schmidt, H. J. Wilke, and G. Bergmann, “Analysis of the influence of disc degeneration on the mechanical behaviour of a lumbar motion segment using the finite element method,” Journal of Biomechanics, vol. 39, no. 13, pp. 2484–2490, 2006.
J. W. Frymoyer, E. N. Hanley, and J. Howe, “A comparison of radiographic findings in fusion and nonfusion patients ten or more years following lumbar disc surgery,” Spine, vol. 4, no. 5, pp. 435–440, 1979.
S. Sano, S. Yokokura, Y. Nagata, and Seong Zeon Young, “Unstable lumbar spine without hypermobility in postlaminectomy cases: mechanism of symptoms and effect of spinal fusion with and without spinal instrumentation,” Spine, vol. 15, no. 11, pp. 1190–1197, 1990.
D. M. Spengler, E. A. Ouellette, M. Battie, and J. Zeh, “Elective discectomy for herniation of a lumbar disc. Additional experience with an objective method,” Journal of Bone and Joint Surgery A, vol. 72, no. 2, pp. 230–237, 1990.