Implantation of a bone-anchored annular closure device in conjunction with tubular minimally invasive discectomy for lumbar disc herniation: a retrospective study

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.

Is annular repair technique useful for reducing reherniation and reoperation after limited discectomy

“…Though the minimally invasive surgery "limited" discectomy is more and more widely used all over the world to maintain the segmental stability after surgery, concerns regarding re-herniation rates due to the small volume of nuclear material removed has not gone away. It is thought by some authors that the remaining large volume of nuclear material and the annular defect because of the primary herniation or surgery incision are the main reason contributing to post-discectomy re-herniation and, ultimately, reoperation [13,14]. In 2006, Carragee et al reported an 18% re-herniation rate after limited discectomy, compared to 9% after aggressive procedures [18].…”

“…2 berwire sutures and PushLock implants [9][10][11][12], and "jetting suture" technique [13]. However, controversy results were reported about the outcomes during follow-up [14,15,11,9,16]. The present study aims to gure out whether the annular repair technique is useful for reducing recurrent LDH after limited discectomy.…”

Lumbar Intervertebral Disc Herniation: Annular Closure Devices and Key Design Requirements

“…Therefore, according to ASTM standards an annular repair strategy must be MRI safe or MRI conditional. For example, even though the Barricaid ® device (Intrinsic Therapeutics, Woburn, MA, USA) has metallic components, it can be safely tested with static magnetic fields of 1.5 and 3 Tesla (maximum spatial gradient magnetic field of 3000 Gauss/cm or less) [ 51 ].…”

“…The flexible polymer mesh forms a mechanical barrier that closes the annular defect and prevents subsequent migration of the nuclear material. This device is available in 8, 10, and 12 mm widths and comes preloaded onto a disposable insertion tool that has already been sterilized [ 51 ]. Clinical outcomes of the Barricaid ® device show promising results [ 52 ], demonstrating that this technique could address some IVD height issues.…”

Anular Closure RCT – Interpretation der Ergebnisse und Bedeutung für die klinische Entscheidungsfindung im Jahr 2019

“…Die Implantation setzt allerdings einen posterolateralen Anulusdefekt voraus, eine mediane oder gar kontralaterale Perforationsstelle sowie ein extraforaminaler Defekt können nicht adressiert werden. Der Eingriff ist auch in tubulärer Technik möglich [10]. Seit der CE-Zertifizierung in 2009 wurden über 7000 chirurgische Eingriffe mit diesem Implantat vorgenommen.…”