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Performance of an Annular Closure Device in a 'Real-World', Heterogeneous, At-Risk, Lumbar Discectomy Population
Adisa Kuršumović1, Stefan Rath1
1Neurosurgery, Spinal Surgery, and Interventional Neuroradiology, Donauisar Klinikum Deggendorf.
Insights
Annular closure devices (ACD) significantly improve outcomes for lumbar disc herniation (LDH) patients undergoing limited discectomy. This technique shows promise in reducing reherniation rates, especially in high-risk patients with large annular defects.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Spinal Surgery
Background:
- Recurrent lumbar disc herniation (rLDH) after limited discectomy remains a significant clinical challenge.
- Large annular defects (≥6 mm) are associated with higher reherniation rates.
- Inadequate annular closure is a key factor contributing to rLDH.
Purpose of the Study:
- To evaluate the effectiveness of an annular closure device (ACD) as an adjunct to limited discectomy for lumbar disc herniation (LDH).
- To assess the impact of ACD on patient outcomes, including pain and disability, and reherniation rates.
Main Methods:
- Retrospective analysis of 171 patients undergoing limited lumbar discectomy with ACD.
- Data collection included Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) pain scores at baseline and follow-up (3 and 12 months).
- Radiographs and MRI scans were used for imaging assessment; complications and secondary surgeries were recorded.
Main Results:
- Mean follow-up was 15 months; 90% of patients had large annular defects.
- Clinically meaningful improvements in ODI and VAS scores were observed in all patients.
- Symptomatic reherniations occurred in 3.5% of patients; ACD mesh detachment in 8.8%.
Conclusions:
- Annular closure with ACD provides clinically meaningful improvements for primary and secondary LDH patients.
- ACD use may decrease reherniation rates in high-risk patients compared to historical discectomy data.
- ACD is a viable adjunct to limited discectomy for managing LDH, particularly in cases with large defects.
Abstract:
Study design/setting Retrospective analysis of single-center registry outcomes data. Objective Assess the utility of an annular closure device (ACD) as an adjunct to limited discectomy for lumbar disc herniation (LDH). Background Recurrent 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. Methods This 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). Results Mean 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). Conclusions Annular 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.