Caner GÜNERBÜYÜK, Mehmet Ali TEPEBAŞILI, İdris GÜRPINAR, Furkan ALMAS, Mehmet Kürşat KARADAĞ, Utku ÖZGEN, Mehmet Yiğit AKGÜN, Özkan ATEŞ, Bekir Tunç ÖKTENOĞLU, Ali Fahir ÖZER
Journal of Turkish Spinal Surgery - 2026;37(3):105-109
Objective: Fragmentectomy represents a tissue-preserving alternative to conventional microdiscectomy. Evidence specifically stratifying outcomes by Carragee lumbar disc herniation type remains limited. To evaluate the clinical outcomes and safety of fragmentectomy in patients with Carragee type I and type III lumbar disc herniations at a single center. Materials and Methods: This retrospective study included 32 consecutive patients who underwent fragmentectomy for Carragee type I (n=18) or type III (n=14) herniations at the L3-S1 levels between 2020 and 2023. The primary outcomes were visual analog scale (VAS) and Oswestry disability index (ODI) scores at 6 and 12 months. Normality was assessed with the Shapiro-Wilk test, and parametric or non-parametric tests were applied accordingly. Subgroup analyses compared outcomes among Carragee subtypes. Results: The mean follow-up was 18 months. VAS scores decreased from 8.20+/-1.10 preoperatively to 0.90+/-0.54 at 12 months (p<0.001; Cohen's d =5.06). ODI improved from 69.33+/-12.78 to 9.70+/-5.18 (p<0.001; Cohen's d =4.27). No significant difference was observed between Carragee subtypes at 12 months (VAS: p=0.065; ODI: p=0.607). Three patients (9.4%) required revision surgery. No intraoperative or postoperative complications were recorded. Conclusion: Fragmentectomy may be an effective, tissue-preserving surgical option for carefully selected patients with Carragee type I and type III lumbar disc herniations. Prospective controlled studies are required to establish superiority over conventional microdiscectomy.
