Incidence of unusual and clinically significant histopathological findings in routine discectomy

Restricted access

Object

Routine histopathological examination of discectomy specimens remains common practice in many hospitals, although it rarely detects unsuspected clinically significant disease. Controversy exists as to the effectiveness of this practice. The objectives of this study were to compare the authors’ experience with a review of the literature.

Methods

In a retrospective database analysis the authors identified all intervertebral disc specimens obtained during spinal procedures over an 8-year period (1996–2004). Cases of benign (nonneoplastic and noninfectious) indications for surgery were included in the study, whereas cases of nonbenign indications were excluded. The final pathological diagnoses were reviewed, and a chart review was performed to determine whether any unexpected findings affected subsequent patient care. A total of 1858 discectomy specimens were identified: 1775 of these were obtained in 1719 routine discectomy procedures. Unexpected histopathological findings were identified in four cases, and none was clinically significant.

Conclusions

Routine histopathological examination of disc specimens is not justified. The decision to send specimens for pathological examination should be determined on a case-by-case basis after consideration of the clinical presentation, results of laboratory and imaging studies, and intraoperative findings.

Abbreviations used in this paper:DDD = degenerative disc disease; MR = magnetic resonance.

Article Information

Address reprint requests to: Daryl R. Fourney, M.D., F.R.C.S.(C), Division of Neurosurgery, University of Saskatchewan, Royal University Hospital, 103 Hospital Drive, Saskatoon, Saskatche-wan S7N 0W8, Canada. email: daryl.fourney@saskatoonhealthregion.ca.

© AANS, except where prohibited by US copyright law.

Headings

References

  • 1

    Boutin PHogshead H: Surgical pathology of the intervertebral disc. Is routine examination necessary?. Spine 17:123612381992

  • 2

    Daftari TKLevine JFischgrund JSHerkowitz HN: Is pathology examination of disc specimens necessary after routine anterior cervical discectomy and fusion?. Spine 21:215621591996

    • Search Google Scholar
    • Export Citation
  • 3

    Grzybicki DMCallaghan EJRaab SS: Costbenefit value of microscopic examination of intervertebral discs. J Neurosurg 89:3783811998

    • Search Google Scholar
    • Export Citation
  • 4

    Hasselblatt MMaintz DGoll TWildforster USchul CPaulus W: Frequency of unexpected and important histopathological findings in routine intervertebral disc surgery. J Neurosurg Spine 4:20232006

    • Search Google Scholar
    • Export Citation
  • 5

    Mihara SKawai SGondo TIshihara T: Intervertebral disc amyloidosis: histochemical, immunohistochemical and ultrastructural observations. Histopathology 25:4154201994

    • Search Google Scholar
    • Export Citation
  • 6

    Perrin RGLaxton AW: Metastatic spine disease: epidemiology, pathophysiology, and evaluation of patients. Neurosurg Clin N Am 15:3653732004

    • Search Google Scholar
    • Export Citation
  • 7

    Reddy PWilliams RWillis BNanda A: Pathological evaluation of intervertebral disc tissue specimens after routine cervical and lumbar decompression. A cost-benefit analysis retrospective study. Surg Neurol 56:2522552001

    • Search Google Scholar
    • Export Citation

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 130 130 33
Full Text Views 36 32 1
PDF Downloads 44 31 0
EPUB Downloads 0 0 0

PubMed

Google Scholar