Comparison of microdiscectomy and microdiscectomy with cage interbody fusion in lumbar–sacral disc herniation

Objective: To optimize the selection of surgical treatment strategy for patients with lumbar and lumbosacral disc herniation by performing a comparative analysis of the outcomes of microdiscectomy and microdiscectomy with interbody cage fusion in order to improve treatment results. Materials and methods: The study included 200 patients with lumbar and lumbosacral disc herniation treated at the Romodanov Neurosurgery Institute of the National Academy of Medical Sciences of Ukraine between 2015 and 2022. Neurological status was assessed based on the severity of pain syndrome, the presence of segmental instability was determined. Magnetic resonance imaging, computed tomography, and radiographic findings were evaluated. The following surgical techniques were used: microdiscectomy for lumbar and lumbosacral disc herniation. Results: Microdiscectomy with interbody cage fusion eliminated manifestations of instability and provided more effective stabilization of the lumbosacral spine compared with microdiscectomy alone. The recurrence rate of disc herniation after microdiscectomy with cage fusion lower (3%) compared with microdiscectomy alone (9%). In the group treated with microdiscectomy and cage fusion, a more pronounced reduction in pain intensity (–82%) and a greater decrease in the Oswestry Disability Index (–81%) were observed, indicating higher effectiveness of the stabilization technique. According to the Macnab and Prolo scales, excellent and good outcomes were recorded more frequently in the microdiscectomy with cage fusion group than in the microdiscectomy group (91% vs 78% and 91% vs. 77%, respectively). The Wilcoxon test confirmed a high level of within-group improvement (p<0.001), while the t-test demonstrated statistically significant differences between the groups. Conclusions: The lumbosacral segment with an implanted cage is more stable and withstands greater mechanical loads during motion, reduces the recurrence rate of disc herniation, and decreases pain severity. Microdiscectomy with interbody cage fusion may be considered in carefully selected patients with signs of segmental instability as an approach that combines decompression and stabilization and is associated with better long-term clinical outcomes.