A sequestrectomy is a surgical procedure in which dead or poorly supplied tissue is removed. This often involves pieces of bone that have broken away from healthy tissue as a result of inflammation or injury. These separated pieces of tissue are known in medicine as sequestra. Removing them is important to stop inflammation, relieve pain and allow the body's natural healing to take place again.
What is a sequestrum?
The term sequestrum refers to a piece of tissue that has become isolated from healthy tissue, usually bone, but sometimes disc material or soft tissue.
Bone sequestrum
In bone inflammation (osteomyelitis), the blood supply to a section of bone can be cut off. The affected piece dies, loses its connection to the healthy bone, and can no longer heal. This leaves behind a sequestrum, which acts like a foreign body inside the body and keeps the inflammation going.
Disc sequestrum
A sequestrum can also occur with a slipped disc. In this case, a part of the disc breaks away completely from its original position and presses on nerves or the spinal cord. This is known as a sequestered disc herniation.
Both types, whether bone or disc sequestrum, share one thing in common: they do not disappear on their own and often cause problems such as pain, inflammation, or restricted movement.
When is a sequestrectomy necessary?
A sequestrectomy is carried out when the dead tissue is causing inflammation, pain, or problems with healing.
Typical situations include:
Chronic bone infections (osteomyelitis) triggered by bacteria
After injuries or operations where blood supply has been disrupted
Dead tissue following an accident or infarction in the bone
Disc sequestra that press on nerve roots and cause severe pain or paralysis
The procedure is usually recommended when conservative treatments such as antibiotics, immobilisation, or pain relief are not enough to remove the cause.
How is a sequestrectomy carried out?
The operation is generally performed under general anaesthetic or local anaesthetic, depending on the size and location of the sequestrum. First, the surgeon opens the affected area and removes the dead tissue completely. The surrounding tissue is then carefully cleaned to remove any bacteria or traces of inflammation. If bone is involved, the resulting cavity is often rinsed and filled with healthy tissue or bone material. In some cases, antibiotic-containing material is also placed inside to prevent a new infection. The procedure usually takes between 30 minutes and 2 hours, depending on the findings.
Risks and chances of success
A sequestrectomy is considered a safe and well-established procedure. However, as with any operation, certain risks exist. These include infections, post-operative bleeding, problems with wound healing, or renewed inflammation if tiny pieces of tissue remain.
In most cases, though, the benefits clearly outweigh the risks. After the dead tissue has been removed, inflammation can settle, pain can reduce noticeably, and the body can form new, healthy tissue. Studies show that the healing rate after a successful sequestrectomy for bone infections is over 90%, provided the infection is fully cleared.
Healing and aftercare
After the operation, the affected area is checked regularly. Depending on the extent of the procedure, immobilisation, dressing changes, or antibiotic treatment may be needed.
Smaller sequestrectomies usually heal within 2 to 4 weeks.
Larger procedures, particularly those involving bone, may need several weeks to months before full stability is restored.
Physiotherapy can help rebuild mobility and muscle strength. Good wound hygiene and follow-up appointments with a doctor are also important, so that any renewed inflammation can be spotted early.
Life after a sequestrectomy
Many patients report feeling significant relief after the sequestrum has been removed, especially if they had been living with chronic pain or recurring infections beforehand. After a sequestrectomy involving bone, the body can usually fill the removed area with new tissue on its own. Only in rare cases, such as with larger defects, is additional stabilisation or reconstruction needed.
With a disc sequestrum, mobility often improves quite quickly once the pressure on the nerves has gone. With patience, targeted movement therapy, and medical follow-up, the chances of a full recovery are very good.
Scientific Sources
Lollino N. Sequestrectomy in primary osteomyelitis of the humerus: a new indication for posterior approach. Tech Hand Up Extrem Surg. 2012;16(4):247-9. https://doi.org/10.1097/BTH.0b013e318270a450
Ambrosio L, Vadalà G, de Rinaldis E, et al. Discectomy versus sequestrectomy in the treatment of lumbar disc herniation: a systematic review and meta-analysis. Spine J. 2024 (online ahead of print). https://doi.org/10.1016/j.spinee.2024.09.007
Ran J, Hu Y, Zheng Z, Zhu T, Zheng H, Jing Y. Comparison of discectomy versus sequestrectomy in lumbar disc herniation: a meta-analysis of comparative studies. PLoS ONE. 2015;10(3):e0121816. https://doi.org/10.1371/journal.pone.0121816
Staribacher D, Feigl GC, Kuzmin D. Role of endoscopic sequestrectomy in the treatment of therapy-resistant radiculopathy in patients with extreme obesity: technical note and case report. J Spine Surg (HK). 2024;10(4). https://doi.org/10.21037/jss-24-36
