Background: It remains unknown whether extensive (subtotal) discectomy versus conservative removal of a disc fragment with little disc invasion provides a better outcome for the treatment of primary symptomatic single level lumbar disc prolapse (LDP). Objective: this prospective study was aiming to compare pain relief and complications rate of extensive discectomy versus fragmentectomy with little disc invasion in patients with primary symptomatic single level LDP. Patients and Methods: all admitted patients to Neurosurgery Department of Benha University Hospital from May 2011 to May 2013 with primary symptomatic single level LDP for discectomy were assigned randomly into 2 groups, group A (extensive discectomy) and group B ( fragmentectomy with little disc invasion) with one year evaluation for pain relief and 2 years follow up for complications. Included patients had low back pain and sciatica but with normal motor power, sensation and intact sphincters. On MRI lumbosacral spine, all patients had primary single level LDP. Results: this study included 60 patients. There were no significant differences between the 2 groups in relief of back and leg pains at 6 and 12 months postoperatively according to VAS scores for back and leg pains. Three patients in group A (10%) and one patient in group B (3.3%) had recurrent lumbar disc prolapse with no significant difference between both groups .The other complications rate were comparable. Group A had longer mean operative time than group B (P> 0.001) Conclusion: it seems that fragmentectomy is a successful alternative technique compared to extensive discectomy in primary single level LDH not only because of comparable results in pain relief and complications rates, but also being less invasive with a shorter operation time and obviously preserving disc height so can delay segmental instability that may be seen after aggressive discectomy.
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