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

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Abstract

Purpose

With lumbar discectomy for disc herniation, surgeons must choose between limited nucleus removal associated with higher reherniation risk or more aggressive nucleus removal associated with increased back pain and disc degeneration. This trade-off is particularly challenging in patients with large anular defects, which carry the highest risk of reherniation. We examined the effect of an anular closure device on reherniation and clinical outcomes.

Methods

Seventy-five primary discectomy patients had a limited discectomy followed by implantation of an anular closure device and were followed-up to 2 years. Anular defect size and volume of removed nucleus was recorded at surgery. Reherniations were reported, pain and function were monitored throughout, and imaging was performed at annual visits.

Results

The overall symptomatic reherniation rate was 1.4 %, and the asymptomatic reherniation rate was 1.5 % at 12 months and 5.1 % at 24 months. Both rates compare favorably with literature reports which include symptomatic rates ranging between 2 and 18 % (up to 27 % for patients with large anular defects) and an asymptomatic rate of 13 %.

Conclusions

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.

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Notes

  1. Revision surgery and device removal was performed on one patient prior to the 12 month time point (see description of symptomatic reherniation). Presentation of clinical outcomes does not include this patient; data from 40 patients in Cohort B were analyzed at 12 months.

References

  1. Gray DT, Deyo RA, Kreuter W, Mirza SK, Heagerty PJ, Comstock BA, Chan L (2006) Population-based trends in volumes and rates of ambulatory lumbar spine surgery. Spine 31:1957–1963

    Article  PubMed  Google Scholar 

  2. Carragee EJ, Spinnickie AO, Alamin TF, Paragioudakis S (2006) A prospective controlled study of limited versus subtotal posterior discectomy: short-term outcomes in patients with herniated lumbar intervertebral discs and large posterior anular defect. Spine 31:653–657

    Article  PubMed  Google Scholar 

  3. Carragee EJ, Han MY, Suen PW, Kim D (2003) Clinical outcomes after lumbar discectomy for sciatica: the effects of fragment type and anular competence. J Bone Joint Surg Am 85-A:102–108

    PubMed  Google Scholar 

  4. Findlay GF, Hall BI, Musa BS, Oliveira MD, Fear SC (1998) A 10-year follow-up of the outcome of lumbar microdiscectomy. Spine 23:1168–1171

    Article  PubMed  CAS  Google Scholar 

  5. Fountas KN, Kapsalaki EZ, Feltes CH, Smisson HF III, Johnston KW, Vogel RL, Robinson JS Jr (2004) Correlation of the amount of disc removed in a lumbar microdiscectomy with long-term outcome. Spine 29:2521–2524

    Article  PubMed  Google Scholar 

  6. Kowalski JM, Olsewski JM, Simmons ED Jr (1995) Results of intervertebral diskectomy without fusion at L4–5 versus L5–S1. J Spinal Disord 8:457–463

    Article  PubMed  CAS  Google Scholar 

  7. Loupasis GA, Stamos K, Katonis PG, Sapkas G, Korres DS, Hartofilakidis G (1999) Seven- to 20-year outcome of lumbar discectomy. Spine 24:2313–2317

    Article  PubMed  CAS  Google Scholar 

  8. Mariconda M, Galasso O, Secondulfo V, Rotonda GD, Milano C (2006) Minimum 25-year outcome and functional assessment of lumbar discectomy. Spine 31:2593–2599

    Article  PubMed  Google Scholar 

  9. Thome C, Barth M, Scharf J, Schmiedek P (2005) Outcome after lumbar sequestrectomy compared with microdiscectomy: a prospective randomized study. J Neurosurg Spine 2:271–278

    Article  PubMed  Google Scholar 

  10. Tureyen K (2003) One-level one-sided lumbar disc surgery with and without microscopic assistance: 1-year outcome in 114 consecutive patients. J Neurosurg 99:247–250

    PubMed  Google Scholar 

  11. Watters WC III, McGirt MJ (2009) An evidence-based review of the literature on the consequences of conservative versus aggressive discectomy for the treatment of primary disc herniation with radiculopathy. Spine J 9:240–257

    Article  PubMed  Google Scholar 

  12. Yorimitsu E, Chiba K, Toyama Y, Hirabayashi K (2001) Long-term outcomes of standard discectomy for lumbar disc herniation: a follow-up study of more than 10 years. Spine 26:652–657

    Article  PubMed  CAS  Google Scholar 

  13. McGirt MJ, Eustacchio S, Varga P, Vilendecic M, Trummer M, Gorensek M, Ledic D, Carragee EJ (2009) A prospective cohort study of close interval computed tomography and magnetic resonance imaging after primary lumbar discectomy: factors associated with recurrent disc herniation and disc height loss. Spine 34:2044–2051

    Article  PubMed  Google Scholar 

  14. Keskimaki I, Seitsalo S, Osterman H, Rissanen P (2000) Reoperations after lumbar disc surgery: a population-based study of regional and interspecialty variations. Spine 25:1500–1508

    Article  PubMed  CAS  Google Scholar 

  15. Martin BI, Mirza SK, Flum DR, Wickizer TM, Heagerty PJ, Lenkoski AF, Deyo RA (2012) Repeat surgery after lumbar decompression for herniated disc: the quality implications of hospital and surgeon variation. Spine J 12:89–97

    Article  PubMed  Google Scholar 

  16. Moliterno JA, Knopman J, Parikh K, Cohan JN, Huang QD, Aaker GD, Grivoyannis AD, Patel AR, Hartl R, Boockvar JA (2010) Results and risk factors for recurrence following single-level tubular lumbar microdiscectomy. J Neurosurg Spine 12:680–686

    Article  PubMed  Google Scholar 

  17. Barth M, Weiss C, Thome C (2008) Two-year outcome after lumbar microdiscectomy versus microscopic sequestrectomy: part 1: evaluation of clinical outcome. Spine 33:265–272

    Article  PubMed  Google Scholar 

  18. McGirt MJ, Ambrossi GL, Datoo G, Sciubba DM, Witham TF, Wolinsky JP, Gokaslan ZL, Bydon A (2009) Recurrent disc herniation and long-term back pain after primary lumbar discectomy: review of outcomes reported for limited versus aggressive disc removal. Neurosurgery 64:338–344

    Article  PubMed  Google Scholar 

  19. Barth M, Diepers M, Weiss C, Thome C (2008) Two-year outcome after lumbar microdiscectomy versus microscopic sequestrectomy: part 2: radiographic evaluation and correlation with clinical outcome. Spine 33:273–279

    Article  PubMed  Google Scholar 

  20. Ambrossi GL, McGirt MJ, Sciubba DM, Witham TF, Wolinsky JP, Gokaslan ZL, Long DM (2009) Recurrent lumbar disc herniation after single-level lumbar discectomy: incidence and health care cost analysis. Neurosurgery 65:574–578

    Article  PubMed  Google Scholar 

  21. Parker SL, Xu R, McGirt MJ, Witham TF, Long DM, Bydon A (2010) Long-term back pain after a single-level discectomy for radiculopathy: incidence and health care cost analysis. J Neurosurg Spine 12:178–182

    Article  PubMed  Google Scholar 

  22. Spengler DM (1982) Lumbar discectomy. Results with limited disc excision and selective foraminotomy. Spine 7:604–607

    Article  PubMed  CAS  Google Scholar 

  23. Fardon DF, Milette PC (2001) Nomenclature and classification of lumbar disc pathology: recommendations of the combined task forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology. Spine 26:E93–E113

    Article  PubMed  CAS  Google Scholar 

  24. Lebow RL, Adogwa O, Parker SL, Sharma A, Cheng J, McGirt MJ (2011) Asymptomatic same-site recurrent disc herniation after lumbar discectomy: results of a prospective longitudinal study with 2-year serial imaging. Spine 36:2147–2151

    Article  PubMed  Google Scholar 

  25. Weber H (1983) Lumbar disc herniation. A controlled, prospective study with ten years of observation. Spine 8:131–140

    Article  PubMed  CAS  Google Scholar 

  26. Weinstein JN, Lurie JD, Tosteson TD, Tosteson AN, Blood EA, Abdu WA, Herkowitz H, Hilibrand A, Albert T, Fischgrund J (2008) Surgical versus nonoperative treatment for lumbar disc herniation: four-year results for the Spine Patient Outcomes Research Trial (SPORT). Spine 33:2789–2800

    Article  PubMed  Google Scholar 

  27. Arts MP, Brand R, van den Akker ME, Koes BW, Bartels RH, Peul WC (2009) Tubular diskectomy vs conventional microdiskectomy for sciatica: a randomized controlled trial. JAMA 302:149–158

    Article  PubMed  CAS  Google Scholar 

  28. Teli M, Lovi A, Brayda-Bruno M, Zagra A, Corriero A, Giudici F, Minoia L (2010) Higher risk of dural tears and recurrent herniation with lumbar micro-endoscopic discectomy. Eur Spine J 19:443–450

    Article  PubMed  Google Scholar 

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Conflict of interest

The authors report no conflict of interest. Intrinsic Therapeutics provided support for the clinical research and data analysis.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Academic Medical Center, St. Lucas-Andreas Ziekenhuis, Jan Tooropstaat 164, 1061 AE, Amsterdam, The Netherlands

    Gerrit J. Bouma

  2. Department of Neurosurgery, University Hospital Mannheim, Mannheim, Germany

    Martin Barth

  3. Department of Neurosurgery, University Hospital of Rijeka, Rijeka, Croatia

    Darko Ledic

  4. Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia

    Milorad Vilendecic

Authors
  1. Gerrit J. Bouma
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  2. Martin Barth
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  3. Darko Ledic
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  4. Milorad Vilendecic
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Correspondence to Gerrit J. Bouma.

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Bouma, G.J., Barth, M., Ledic, D. et al. The high-risk discectomy patient: prevention of reherniation in patients with large anular defects using an anular closure device. Eur Spine J 22, 1030–1036 (2013). https://doi.org/10.1007/s00586-013-2656-1

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  • DOI: https://doi.org/10.1007/s00586-013-2656-1

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