Annular closure device for disc herniation: meta-analysis of clinical outcome and complications

Choy, Wen Jie; Phan, Kevin; Diwan, Ashish D.; Ong, Chon Sum; Mobbs, Ralph J.

doi:10.1186/s12891-018-2213-5

Cited by 43 publications

(41 citation statements)

References 49 publications

(60 reference statements)

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“…With regards to this case, postoperative objective accelerometer measurements demonstrated improvements of 60% in distance walked per day, number of steps taken and GV at 1-month follow-up, compared to preoperative measures. The sudden drop in functional status at day 57 was prominent, thus verifying the value of objective measurements with assistance in identifying the postoperative complication, such as recurrent disc herniation, a common yet undesirable outcome of microdiscectomy (17,18).…”

Section: Discussionmentioning

confidence: 70%

Objective monitoring of activity and Gait Velocity using wearable accelerometer following lumbar microdiscectomy to detect recurrent disc herniation

Mobbs¹,

Katsinas²,

Choy³

et al. 2018

J Spine Surg

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We report a case of a 39-year-old male with sciatica who underwent an L5/S1 microdiscectomy with objective physical activity measurements performed preoperatively and continually postoperatively up to 3-month using wireless accelerometer technology linked to the surgical practice; collecting distance travelled, daily step count (DSC) and Gait Velocity (GV). Preoperative, the patient was walking with a GV of 0.97 m/s and a DSC of less than 2,500. After the first month following surgery, the patient had increased mobility, with a GV of 1.58 m/s, and taking an average of over 4,500 steps per day. At day 57 postop, the patient experienced a recurrence of pain with reduction of GV, DSC and walking distance. Magnetic resonance imaging (MRI) was performed and revealed a recurrent disc herniation with further surgery on day 63, with a rapid return of function post 2 nd surgery. The use of wireless accelerometers is practical in obtaining objective physical activity measurements before and after lumbar microdiscectomy, and will assist the surgeon and rehabilitation provider to monitor outcomes, complications and assist in clinical decision making.

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Section: Discussionmentioning

confidence: 70%

Objective monitoring of activity and Gait Velocity using wearable accelerometer following lumbar microdiscectomy to detect recurrent disc herniation

Mobbs¹,

Katsinas²,

Choy³

et al. 2018

J Spine Surg

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“…These annular closure devices (ACDs) have been the subject of pre-clinical and early clinical studies [15,22,42], with the early evidence providing some evidence in support of their use. A recent meta-analysis performed [43] of four clinical studies [42,[44][45][46] investigating two current ACD technologies cited similar positive results from both devices, although the relatively limited clinical data prevented the authors from drawing firm conclusions on the overall effectiveness of these devices. Another recent randomized, controlled trial comparing lumbar discectomy plus bone-anchored annular closure with lumbar discectomy alone showed a significant improvement in all outcomes, including the rates of recurrent herniation (50% vs. 70%, p < 0.001), symptomatic reherniation (18% vs. 27%, p = 0.02) and reoperation (12% vs. 25%, p < 0.001) [47].…”

Section: Discussionmentioning

confidence: 99%

The Disability Cascade: A Preventable Consequence of the Loss of Disc Height following Lumbar Microdiscectomy

Kursumovic

Muir

Ammerman

et al. 2019

Cureus

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Lumbar discectomy is a mainstay surgical treatment for herniation of the lumbar discs and is effective at treating radicular symptomology. Despite the overall success of the procedure; the potential for reherniation and reoperation is significant. To avoid this potential recurrence, surgeons often perform discectomy more aggressively, removing a larger volume of nuclear material in the hopes of minimizing the likelihood of reherniation. This approach, while beneficial in minimizing the chance of reherniation, is associated with a volumetric reduction of the nucleus within the disc space, making the disc more prone to collapse and thus inducing a significant post-operative loss of disc height. While potentially minor in isolation, the loss of disc height, in fact, impacts several aspects of overall patient well-being. We hypothesize that the loss of disc height following discectomy causes an increase in pain and subsequent disability, the combination of which ultimately impacts socioeconomic factors affecting both the patient and the healthcare system as a whole. In this report, we outline the evidence in support of this disability cascade and provide recommendations on methods for limiting its impact. Given the current focus on cost-effectiveness in healthcare decision-making, methods for limiting this potentially damaging sequence of events must be investigated.

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“…81 The study, reported in the these reports also highlighted that device implantation led to higher prevalence of endplate changes. [82][83][84][85] The long-term efficacy and safety of the device, especially concerning the damage of the vertebral bone and endplate during device fixation, remains to be determined.…”

Section: Injury Manifestations Diagnosis and Patient Demographicsmentioning

confidence: 99%

A challenging playing field: Identifying the endogenous impediments to annulus fibrosus repair

et al. 2021

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Intervertebral disc (IVD) herniations, caused by annulus fibrosus (AF) tears that enable disc tissue extrusion beyond the disc space, are very prevalent, especially among adults in the third to fifth decade of life. Symptomatic herniations, in which the extruded tissue compresses surrounding nerves, are characterized by back pain, numbness, and tingling and can cause extreme physical disability. Patients whose symptoms persist after nonoperative intervention may undergo surgical removal of the herniated tissue via microdiscectomy surgery. The AF, however, which has a poor endogenous healing ability, is left unrepaired increasing the risk for re-herniation and pre-disposing the IVD to degenerative disc disease. The lack of understanding of the mechanisms involved in native AF repair limits the design of repair systems that overcome the impediments to successful AF restoration. Moreover, the complexity of the AF structure and the challenging anatomy of the repair environment represents a significant challenge for the design of new repair devices. While progress has been made towards the development of an effective AF repair technique, these methods have yet to demonstrate long-term repair and recovery of IVD biomechanics. In this review, the limitations of endogenous AF healing are discussed and key cellular events and factors involved are highlighted to identify potential therapeutic targets that can be integrated into AF repair methods. Clinical repair strategies and their limitations are described to further guide the design of repair approaches that effectively restore native tissue structure and function.

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Annular closure device for disc herniation: meta-analysis of clinical outcome and complications

Cited by 43 publications

References 49 publications

Objective monitoring of activity and Gait Velocity using wearable accelerometer following lumbar microdiscectomy to detect recurrent disc herniation

Objective monitoring of activity and Gait Velocity using wearable accelerometer following lumbar microdiscectomy to detect recurrent disc herniation

The Disability Cascade: A Preventable Consequence of the Loss of Disc Height following Lumbar Microdiscectomy

A challenging playing field: Identifying the endogenous impediments to annulus fibrosus repair

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