2.10. Disc Curettage
@ProfFishchenkoPrevious section: 2.9. Bone Resection
In my BESS/UBE practice, I determine the extent of disc material removal based on the morphology of the herniation and the intraoperative findings. My aim is to relieve compression of neural structures while avoiding unjustified removal of disc tissue.
Choosing the extent of the procedure
When there is a free sequestered fragment that is no longer connected to the disc and no visible defect in the annulus fibrosus, I remove the fragment without performing an additional annulotomy.
After removing the herniated fragment, I determine the need for and extent of intradiscal exploration according to the intraoperative findings. I use a shaver to remove loose fragments remaining within the disc.
Safe use of the shaver
Suction through the shaver's working window may capture adjacent tissue and injure a nerve root or dural structures. I continue to control the position of the working window and the depth of insertion after the blade enters the disc, preventing contact with neural structures.
In this clip, I show the moment of unintentional contact between the shaver and a nerve during disc curettage.
References
1. Costa F, Oertel J, Zileli M, Restelli F, Zygourakis CC, Sharif S. Role of surgery in primary lumbar disk herniation: WFNS spine committee recommendations. World Neurosurg X. 2024;22:100276. doi:10.1016/j.wnsx.2024.100276.
2. Thomé C, Barth M, Scharf J, Schmiedek P. Outcome after lumbar sequestrectomy compared with microdiscectomy: a prospective randomized study. J Neurosurg Spine. 2005;2(3):271–278. doi:10.3171/spi.2005.2.3.0271.
3. Barth M, Diepers M, Weiss C, Thomé C. Two-year outcome after lumbar microdiscectomy versus microscopic sequestrectomy: part 2: radiographic evaluation and correlation with clinical outcome. Spine (Phila Pa 1976). 2008;33(3):273–279. doi:10.1097/BRS.0b013e31816201a6.
4. Carragee EJ, Han MY, Suen PW, Kim D. Clinical outcomes after lumbar discectomy for sciatica: the effects of fragment type and anular competence. J Bone Joint Surg Am. 2003;85(1):102–108. PubMed.
5. Fardon DF, Williams AL, Dohring EJ, Murtagh FR, Rothman SLG, Sze GK. Lumbar disc nomenclature: version 2.0: Recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology. Spine J. 2014;14(11):2525–2545. doi:10.1016/j.spinee.2014.04.022.
Previous section: 2.9. Bone Resection