Performance of an Annular Closure Device in a 'Real-World', Heterogeneous, At-Risk, Lumbar Discectomy Population.

Adisa Kuršumović,Stefan Rath

doi:10.7759/cureus.1824

Abstract

Study design/settingRetrospective analysis of single-center registry outcomes data.ObjectiveAssess the utility of an annular closure device (ACD) as an adjunct to limited discectomy for lumbar disc herniation (LDH).BackgroundRecurrent lumbar disc herniation (rLDH) following limited discectomy persists at clinically significant rates, especially in large annular defect (at least 6 mm width) patients. While the etiology of reherniation is often multifactorial, inadequate annular occlusion remains one of the foremost considerations. Accordingly, annular closure has emerged as a promising technique and is the focus of this analysis.MethodsThis was a retrospective analysis of 171 patients who underwent limited lumbar discectomy with an ACD for LDH. Standardized patient assessment was performed preoperatively, three months postoperatively, and 12 months postoperatively, in addition to self-presented visits. No minimum last follow-up was required for inclusion. Oswestry Disability Index (ODI) and Visual Analog Scale (VAS Leg/Back) pain scores were collected at all visits. Plain radiographs were obtained at all visits, with magnetic resonance imaging (MRI) scans performed annually and/or when patients presented as symptomatic. ACD-related complications due to partial or complete mesh detachment from the titanium anchor were reported. All secondary surgical interventions were also reported. The Wilcoxon Rank-sum test was used to compare outcomes and events between sub-groups (p < 0.05).ResultsMean last follow-up for all patients was 15 months. Large annular defects were present in 154 patients (90%). Symptomatic reherniations were observed in six patients (3.5%; five were present in the large annular defect subpopulation). All patients demonstrated clinically meaningful improvement in clinical outcome scores at both follow-up intervals. ACD mesh detachment was observed in 15 patients (8.8%; two underwent a subsequent surgical intervention). No symptomatic reherniations were observed in secondary herniation patients compared to six (4.1%) in the primary herniation group (p = 0.60).ConclusionsAnnular closure with the ACD results in clinically meaningful improvements in both primary and secondary LDH patients, with decreased rates of reherniation in high-risk patients compared to previous discectomy reports.

Highlights

Of all spinal procedures performed, lumbar discectomy for disc herniation is the most common, with approximately 300,000 annual procedures in the United States alone [1,2,3]
Recurrent lumbar disc herniation following limited discectomy persists at clinically significant rates, especially in large annular defect patients
Symptomatic reherniations were observed in six patients (3.5%; five were present in the large annular defect subpopulation)

Summary

Introduction

Of all spinal procedures performed, lumbar discectomy for disc herniation is the most common, with approximately 300,000 annual procedures in the United States alone [1,2,3]. In addition to the risks associated with exposing the patient to another surgery, the economic burden of treating symptomatic reherniation is substantial, with direct and indirect costs estimated at $34,242 and $3,778, respectively [1, 16]. These patients are at considerable risk for additional, ancillary, spinal surgery, with the tendency to achieve poorer results with each subsequent intervention [8, 11, 17, 18]. Annular closure has emerged as a promising technique and is the focus of this analysis

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Results

Conclusion