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• W2149807650 abstract "We read the review on “An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy” by Kreiner at al. [ [1] Kreiner D.S. Hwang S.W. Easa J.E. et al. An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy. Spine J. 2014; 14: 180-191 Abstract Full Text Full Text PDF PubMed Scopus (280) Google Scholar ] with great interest. We send our kudos to the authors for their excellent work. Their very practical questions are near to a spine surgeon's everyday work. Therefore, the questions will be fundamental to future discussions. The intention of this letter is to follow their impulse for discussion. We would like to focus on the recommendation (Grade I, ie, insufficient evidence) for or against the performance of aggressive discectomy or sequestrectomy for the avoidance of chronic low back pain in patients with lumbar disc herniation with radiculopathy whose symptoms warrant surgery (Question 24). From the given references, the conclusions can, in our opinion, hardly be drawn. The discectomy is explicitly described as “to remove … the loose intradiscal tissue” [ [2] Barth M. Weiss C. Thome C. Two-year outcome after lumbar microdiscectomy versus microscopic sequestrectomy: part 1: evaluation of clinical outcome. Spine. 2008; 33: 265-272 Crossref PubMed Scopus (93) Google Scholar ] or “no attempt was made to use curettes, and injury to the cartilaginous endplates has been avoided” [ [3] Thome C. Barth M. Scharf J. Schmiedek P. Outcome after lumbar sequestrectomy compared with microdiscectomy: a prospective randomized study. J Neurosurg Spine. 2005; 2: 271-278 Crossref PubMed Scopus (142) Google Scholar ]. In our opinion, this is not a description of “aggressive discectomy.” Moreover, there might be a bias in the article by Schick and Elhabony [ [4] Schick U. Elhabony R. Prospective comparative study of lumbar sequestrectomy and microdiscectomy. Minim Invasive Neurosurg. 2009; 52: 180-185 Crossref PubMed Scopus (24) Google Scholar ], and the follow-up rate in either technique is below 47%; therefore, their results must be interpreted with caution." @default.
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• W2149807650 date "2014-09-01" @default.
• W2149807650 modified "2023-10-14" @default.
• W2149807650 title "Comment on “An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy”" @default.
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• W2149807650 doi "https://doi.org/10.1016/j.spinee.2014.04.021" @default.
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