Abstract
BackgroundMinimally invasive techniques for lumbar discectomy have been recommended as superior to open techniques due to lower blood loss, lower rates of infection and shorter recovery. There are, however, concerns that this approach does not sufficiently remove the herniated nuclear material, thus leaving the patient susceptible to reherniation requiring reoperation. The purpose of this study was to examine the safety and viability of an annular closure device in limiting reherniation and reoperation in a cohort of patients undergoing minimally invasive lumbar discectomy with the assistance of an annular closure device.MethodsWe retrospectively analysed the results from patients treated by a single surgeon between March 2011 and December 2017. All patients had been diagnosed with a large (≥ 5 mm) defect and were treated via minimally invasive surgical techniques. Outcomes included demographic data, the procedural duration and the rates of symptomatic reherniation and reoperation.Results60 patients were included in the study. The mean age was 42 years (range: 19–66); mean BMI was 24.1 (range: 16.7–36.3). Mean surgical duration was 29 min (range: 16–50). Reoperation was required in 5% (3/60) of patients, although only 3% (2/60) experienced symptomatic reherniation at the index level. No other complications were reported.ConclusionsIn our study, the use of an annular closure device during minimally invasive lumbar discectomy in a population of patients with large herniations was associated with low rates of reherniation and reoperation at the index level. While more research is required, the results of this study demonstrate the safety and viability of the annular closure device as an adjunct to minimally invasive discectomy.
Highlights
Invasive techniques for lumbar discectomy have been recommended as superior to open techniques due to lower blood loss, lower rates of infection and shorter recovery
Surgical discectomy has been proven as an effective treatment for lumbar intervertebral herniation; despite refinements of surgical approach and technique, there remains a persistent risk of recurrent reherniation at the index level [1,2,3]
Implantation of the annular closure device (ACD) as an adjunct to limited tubular minimally-invasive lumbar discectomy was indicated in patients who met the following indications: 1) unilateral, single level lumbar disc herniation demonstrated on computed tomography and/ or magnetic resonance imaging; 2) persistent radiculopathy and positive tension signs in both straight and crossed leg raising tests; 3) concordant radicular neurological deficits; and 4) intra-operative measurement of a large annular defect measuring 5–12 mm in width
Summary
Invasive techniques for lumbar discectomy have been recommended as superior to open techniques due to lower blood loss, lower rates of infection and shorter recovery. Traditional discectomy techniques, first pioneered over 80 years ago, have been associated with generally good results but have raised concerns regarding increased rates of surgical site infection [9, 10] and increased blood loss [11]. Such concerns have spurred the development of minimally invasive surgical (MIS) techniques that offer similar patient outcomes but without the added risks associated with traditional methods [11, 12]. While clinical outcomes have been shown to be equivalent between open and tubular techniques, there are concerns regarding reherniation rates, as minimal removal of nuclear material is thought by some authors to contribute to post-discectomy reherniation and, reoperation [13, 14]
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