Needle-Guided Suture Technique for Lumbar Annular Fiber Closure in Microendoscopic Discectomy: A Technical Note and Case Series

Abstract

Departmental sources Background: Annular fiber closure techniques have been proven effective in reducing short-term recurrence after discectomy. However, annular fiber closure devices are expensive and still fail at a low rate. We present a novel suture method, needle-guided annular closure suture (NGACS) that does not require a special device and can be performed for annular fiber closure following microendoscopic discectomy. Material/Methods: Twenty-five patients who underwent treatment with NGACS were reviewed by analysis of the medical records. The clinical outcomes were assessed and compared preoperatively and immediately, 1, 6, and 12 months postoperatively. The parameters included the Visual Analog Scale (VAS)-back and VAS-leg scores and the Oswestry Disability Index (ODI). Midsagittal T2WI images were obtained to evaluate lumbar disc degeneration using the Pfirrmann grade. Additional adverse events were also recorded and tracked. Results: The VAS-back and VAS-leg scores and the ODI were significantly different at each follow-up time point (P<0.001), and improvements in pain and disability were maintained well during the follow-up period. Lumbar disc reherniation or other serious adverse events were not observed in this series. There was no significant difference between the initial and final Pfirrmann grades (Z=-1.414, P=0.157). The preoperative average disc height was 9.94±1.97 mm, and the disc height at 12 months after surgery was 9.14±1.88 mm. The average decrease in disc height was 8.11±3.36%. Conclusions: This study demonstrates the feasibility and superior clinical outcomes of the NGACS technique. This method can be a good substitution when annular fiber closure devices are not available. Moreover, this technique can be easily popularized due to its low cost and few restrictions.

The association between pain scores and disc height change following discectomy surgery in lumbar disc herniation patients: a systematic review and meta-analysis

“…In the method-1a group, the mean initial DH was 9.4 mm and the reduction in DH ranged from 5.2% to 26%. As shown in Table 3, there was a significant relationship between the reduction in DH and decrease in back pain score (r = 0.68, (95% CI = 0.07-1.30), p = 0.034) after discectomy surgery [28,31,32,36,[41][42][43][44]. The same statistically significant relationship occurred in the method-1b group (r = 0.74, (95% CI = 0.08-1.40), p = 0.033) [28,31,32,36,[41][42][43].…”

“…As shown in Table 3, there was a significant relationship between the reduction in DH and decrease in back pain score (r = 0.68, (95% CI = 0.07-1.30), p = 0.034) after discectomy surgery [28,31,32,36,[41][42][43][44]. The same statistically significant relationship occurred in the method-1b group (r = 0.74, (95% CI = 0.08-1.40), p = 0.033) [28,31,32,36,[41][42][43]. Based on different follow-up period in each measurement group for subgroup analysis, no significant association was found between the change in DH and decrease in clinical scores (Table 3).…”

“…1). Eighteen studies met the selection criteria for the purposes of the present review, which included two RCTs [27,28] and 16 observational studies [12,[29][30][31][32][33][34][35][36][37][38][39][40][41][42][43].…”

“…DH method-1b on L1/2-L5S1: average of anterior, middle, and posterior DH = (a + b + c)/3) to measure the DH [28,29,31,32,36,[41][42][43].…”

“…Based on all of the ten included studies, the change in DH after discectomy surgery showed 14.4% reduction (SMD = −0.74 (95% CI = −0.86 to −0.61), I 2 = 23.6%, P = 0.226) [28-32, 36, 37, 41-43]. There was a 17.3% reduction in DH in the method-1a group [30,37] (SMD = −0.74 (95% CI = −0.97 to −0.51) and 12.6% reduction in the method-1b group [28,29,31,32,36,[41][42][43] (SMD = −0.73 (95% CI = −0.88 to −0.59)) after discectomy surgery by mixed effect model (Fig. 3).…”