A Novel Approach to the Surgical Treatment of Lumbar Disc Herniations: Indications of Simple Discectomy and Posterior Transpedicular Dynamic Stabilization Based on Carragee Classification
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 [1]. 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 [2]. 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 [5]. 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
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