Additive Benefit Analysis of Spinal Discectomy Tissue Specimens

Year 2025, Volume: 7 Issue: 3, 568 - 72, 09.09.2025

Burhan Oral Güdü

https://doi.org/10.37990/medr.1663668

Abstract

Aim: The necessity of performing routine histopathological examinations on intervertebral disc specimens obtained during microdiscectomy remains a matter of debate with limited data available in the current literature. This study aimed to evaluate whether such routine examinations provide additional diagnostic or therapeutic value.
Material and Method: A total of 224 intervertebral disc specimens (78 cervical, 146 lumbar) obtained from 190 consecutive patients who underwent surgery for symptomatic disc herniation between 2017 and 2021 were retrospectively analyzed. Clinical, radiological, intraoperative, and histopathological findings were systematically analyzed and compared.
Results: The most frequently affected levels were C5–C6 and C6–C7 in the cervical spine, and L4–L5 and L5–S1 in the lumbar spine. A statistically significant difference was observed in the type of herniation between the cervical and lumbar regions (p=0.0005). Histopathological examination revealed degenerative changes in all specimens. In one case, polymorphonuclear cell infiltration was noted; however, there were no supporting clinical or radiological signs suggestive of discitis. In another case, the intraoperative discovery of black disc material led to a diagnosis of alkaptonuria, which was later confirmed by genetic analysis.
Conclusion: Routine histopathological examination of intervertebral disc specimens obtained during microdiscectomy did not contribute to diagnosis or treatment planning in our study. Given the low diagnostic yield and additional cost, such evaluations should be reserved for selected cases with specific clinical, radiological, or intraoperative suspicion.

Keywords

Microdiscectomy , histopathological examination , intervertebral disc , degenerative disc disease , cost-effectiveness

Ethical Statement

The study protocol was approved by the Ethics Committee of Kanuni Sultan Süleyman Research and Training Hospital (Approval Date: November 26, 2021; Approval Number: 2021.11.286).

References

• Bihorac F, Beculić H, Begagić E, et al. Histopathological spectrum of lumbar disc changes in obesity: analysis of intervertebral discs in lumbar hernia patients in Zenica-Doboj Canton, Bosnia and Herzegovina. Med Glas. 2024;21:140-6.
• Kilitci A, Asan Z, Yuceer A, et al. Comparison of the histopathological differences between the disc material and posterior longitudinal ligament in patients with lumbar disc herniation: A focus on the etiopathogenesis. Ann Saudi Med. 2021;41:115-20.
• Diaconu GS, Mihalache CG, Popescu G, et al. Clinical and pathological considerations in lumbar herniated disc associated with inflammatory lesions. Rom J Morphol Embryol. 2021;62:951-60.
• Reddy P, Williams R, Willis B, Nanda A. Pathological evaluation of intervertebral disc tissue specimens after routine cervical and lumbar decompression: a cost-benefit analysis retrospective study. Surg Neurol. 2001;56:252-5.
• Ford JJ, Kaddour O, Gonzales M, et al. Clinical features as predictors of histologically confirmed inflammation in patients with lumbar disc herniation with associated radiculopathy. BMC Musculoskelet Disord. 2020;21:567.
• Yaltırık K, Güdü BO, Işık Y, et al. Volumetric muscle measurements indicate significant muscle degeneration in single-level disc herniation patients. World Neurosurg. 2018;116:e500-4.
• Cavuşoğlu H, Türkmenoğlu O, Kaya RA, et al. Effects of anterior contralateral cervical microdiskectomy on radiological and clinical outcome. Surg Neurol. 2006;65:446-53.
• Binder AI. Cervical spondylosis and neck pain. BMJ. 2007;334:527-31.
• Güdü BO. Effectiveness of cervical disc arthroplasty in cervical vertigo. J Turk Spinal Surg 2025;36:29-34.
• McCormick WE, Will SF, Benzel EC. Surgery for thoracic disc disease. Complication avoidance: overview and management. Neurosurg Focus. 2000;9:13.
• Koebbe CJ, Maroon JC, Abla A, et al. Lumbar microdiscectomy: a historical perspective and current technical considerations. Neurosurg Focus. 2002;13:E3.
• Ammar A, Alwadei A, Hayek AA, et al. The correlation between histopathology of herniated lumbar intervertebral disc and clinical findings. Asian J Neurosurg. 2022;15:545-53.
• Boutin P, Hogshead H. Surgical pathology of the intervertebral disc. Is routine examination necessary?. Spine. 1992;17:1236-8.
• Apaydin AS, Bozyiğit B, Koç-Apaydin Z, et al. Effects of different surgical treatments on pain, disability, anxiety and quality of life in lumbar disc herniation. Cir Cir. 2024;92:39-45.
• Güneş M, Apaydın AS, Keskin NK. Investigation of lumbar multifidus muscle, pain, and fear of falling in patients with lumbar spinal stenosis with poor balance. Clin Neurol Neurosurg. 2024;246:108578.
• Grzybicki DM, Callaghan EJ, Raab SS. Cost-benefit value of microscopic examination of intervertebral discs. J Neurosurg. 1998;89:378-81.
• Manchikanti L, Singh V, Falco FJE, et al. Epidemiology of low back pain in adults. Neuromodulation Technol Neural Interface. 2014;17:3-10.
• Hurwitz EL, Randhawa K, Yu H, et al. The Global Spine Care Initiative: a summary of the global burden of low back and neck pain studies. Eur Spine J. 2018;27:796-801.
• Hoy D, Brooks P, Blyth F, Buchbinder R. The epidemiology of low back pain. Best Pract Res Clin Rheumatol. 2010;24:769-81.
• Wu AS, Fourney DR. Incidence of unusual and clinically significant histopathological findings in routine discectomy. J Neurosurg Spine. 2006;5:410-3.
• Hasselblatt M, Maintz D, Goll T, et al. Frequency of unexpected and important histopathological findings in routine intervertebral disc surgery. J Neurosurg Spine. 2006;4:20-3.
• Daftari TK, Levine J, Fischgrund JS, Herkowitz HN. Is pathology examination of disc specimens necessary after routine anterior cervical discectomy and fusion?. Spine. 1996;21:2156.
• Clark R, Weber RP, Kahwati L. Surgical management of lumbar radiculopathy: a systematic review. J Gen Intern Med. 2020;35:855-64.
• Keller RB, Atlas SJ, Soule DN, et al. Relationship between rates and outcomes of operative treatment for lumbar disc herniation and spinal stenosis. J Bone Joint Surg Am. 1999;81:752-62.