Abstract
BackgroundAn annular closure device (ACD) could potentially prevent recurrent herniation by blocking larger annular defects after limited microdiscectomy (LMD). The purpose of this study was to analyze the incidence of endplate changes (EPC) and outcome after LMD with additional implantation of an ACD to prevent reherniation.MethodsThis analysis includes data from a) RCT study-arm of patients undergoing LMD with ACD implantation and b) additional patients undergoing ACD implantation at our institution. Clinical findings (VAS, ODI), radiological outcome (reherniation, implant integrity, volume of EPC) and risk factors for EPC were assessed.ResultsSeventy-two patients (37 men, 47 ± 11.63yo) underwent LMD and ACD implantation between 2013–2016. A total of 71 (99%) patients presented with some degree of EPC during the follow-up period (14.67 ± 4.77 months). In the multivariate regression analysis, localization of the anchor was the only significant predictor of EPC (p = 0.038). The largest EPC measured 4.2 cm3. Reherniation was documented in 17 (24%) patients (symptomatic: n = 10; asymptomatic: n = 7). Six (8.3%) patients with symptomatic reherniation underwent rediscectomy. Implant failure was documented in 19 (26.4%) patients including anchor head breakage (n = 1, 1.3%), dislocation of the whole device (n = 5, 6.9%), and mesh dislocation into the spinal canal (n = 13, 18%). Mesh subsidence within the EPC was documented in 15 (20.8%) patients. Seven (9.7%) patients underwent explantation of the entire, or parts of the device.ConclusionClinical improvement after LMD and ACD implantation was proven in our study. High incidence and volume of EPC did not correlate with clinical outcome. The ACD might prevent disc reherniation despite implant failure rates. Mechanical friction of the polymer mesh with the endplate is most likely the cause of EPC after ACD.
Highlights
An annular closure device (ACD) could potentially prevent recurrent herniation by blocking larger annular defects after limited microdiscectomy (LMD)
It was shown that the frequency of symptomatic reherniation and reoperation was lower in the ACD compared to the control group—with a similar outcome over a 3-year period [12, 23]
Lumbar disc herniation patients scheduled for LMD with a posterior disc height of at least 5 mm were offered ACD implantation
Summary
An annular closure device (ACD) could potentially prevent recurrent herniation by blocking larger annular defects after limited microdiscectomy (LMD). The purpose of this study was to analyze the incidence of endplate changes (EPC) and outcome after LMD with additional implantation of an ACD to prevent reherniation. Symptomatic recurrent herniation management is either conservative or with repeat surgery including discectomy or fusion [18]. An annular closure device (ACD) (Barricaid®, Intrinsic Therapeutics, Inc., Woburn, MA) was recently introduced and could potentially prevent recurrent herniation by blocking larger annular defects after LMD, and preserve the nucleus pulposus within the disc space [19]. It was shown that the frequency of symptomatic reherniation and reoperation was lower in the ACD compared to the control group—with a similar outcome over a 3-year period [12, 23]. The aim of the present study is to share our institution’s experience with EPC following LMD with additional implantation of an ACD
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