The high-risk discectomy patient: prevention of reherniation in patients with large anular defects using an anular closure device

Abstract

The low reherniation rate in patients at high-risk of reherniation based on anular defect size, despite discectomy being only limited, suggests that an anular closure device may reduce reherniation risk. Clinical outcomes for pain and function at 1 and 2 years post-operatively compared favorably with literature reports. Further study in a randomized controlled trial is required to confirm these results.

Risk Factors for Reoperation in Patients Treated Surgically for Intervertebral Disc Herniation

“…High reoperation rates have been reported in the literature, and several studies have shown inferior outcomes for patients who undergo reoperation 7,12,18,21,22 . This investigation focused on improving clinicians' understanding of risks and outcomes when indicating IDH patients for surgery, thus improving long-term outcomes and minimizing unnecessary costs and morbidity associated with multiple operations.…”

“…The advent of new technology has helped with improving outcomes and decreasing complications, and, as we now have the tools to better analyze outcome data and treatment effects, a better understanding of predictors of reoperation will enhance our ability to indicate treatment in and manage patients with IDH. Prior studies have investigated risk factors, such as age, comorbidities, type of discectomy, and disc morphology, that may be predictive of reoperation 9,11,12,[18][19][20][21] . However, most of these reports are from single institutions or surgeons, or were limited in background and clinical data.…”

Effects of Level, Loading Rate, Injury and Repair on Biomechanical Response of Ovine Cervical Intervertebral Discs

“…Besides contributing to reherniation risk, defects in the annulus result in altered biomechanical response (30–32), decreased cellularity (33), accelerated degeneration (34) and decreased IVD height (25). The Barricaid (Intrinsic Therapeutics, Inc., Woburn, Massachusetts), a shield within the annulus fibrosus secured to the inferior vertebral body (35) prevents reherniation (36) and protects the facet joint (37), but does not seal AF defects. Developing biomaterials that can seal AF defects is an area of active research (38).…”

Anular closure device: is it necessary after discectomy?

“…Dear Editor, I read with great interest the article by Bouma et al [1] published in European Spine journal entitled ''The highrisk discectomy patient: prevention of reherniation in patients with large anular defects using an anular closure device (ACD)''. The authors have evaluated ACD's ability to reduce reherniation risk after lumbar disc surgery.…”

“…The surgical technique chosen in this study was limited discectomy followed by implantation of an ACD. According to the authors, the low reherniation rate in patients at high risk of reherniation based on anular defect size, despite discectomy being only limited, suggests that an ACD may reduce reherniation risk [1]. This conclusion is based on several assumptions: (1) Higher risk of herniation is correlated with poor annular competence, (2) ACD is able to retain the nucleus pulposus within the confines of the disc space, and (3) limited removal of nucleus is associated with low reherniation risk.…”