Article
Real world experience with an anular closure device
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Authors
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A. Kursumovic
- Klinik für Neurochirurgie und interventionelle Neuroradiologie, Klinikum Deggendorf, Deggendorf, Deutschland
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S. Rath
- Klinik für Neurochirurgie und interventionelle Neuroradiologie, Klinikum Deggendorf, Deggendorf, Deutschland
| Published: | June 4, 2012 |
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Outline
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Objective: Microsurgical discectomy is the gold standard treatment for primary lumbar disc herniation patients unresponsive to conservative treatment. Surgeons must decide between aggressive nucleus removal, leading to greater back pain and disc height loss, and conservative nucleus removal, leading to higher reherniation rates. Anular closure devices (ACD), which seal the anular defect found or created during surgery, may allow for minimal nucleus removal with reduced reherniation risk. The Barricaid endoprosthesis is an ACD, which consists of a woven PET mesh intended to block an anular defect while anchored to an adjacent vertebral body by a Ti bone anchor.
Methods: 118 patients have been treated with the ACD since September 2009. ODI, back, and leg VAS were completed pre-operatively, and at each follow-up. Clinical exams, standing, and functional x-rays were assessed at each time-point, with MRs taken at 12 months. Reherniations and device integrity were noted.
Results: Mean patient age was 46.5 years, and the male-female ratio was 1.4. Average anular defect size was 42.1 mm2. Follow-up ranged from 24 to 500 days. Three symptomatic reherniations have occurred (2.5%), with one additional asymptomatic reherniation. Two mesh dislocations have occurred, both in patients whose defect was larger than allowed per instructions, and one anchor has moved within the vertebral body. Mesh-endplate interactions were observed in 5 patients without clinical significance. Comparing average scores at pre-op vs. latest follow-up, the following observations were noted: decrease in ODI from 52.9 pre-op to 17.1, decrease in back pain from 61.8 pre-op to 27.8, and a decrease in leg pain from 79.1 pre-op to 21.4.
Conclusions: The symptomatic reherniation rate of 2.5% among 118 patients who are an average of 15 months post-op compares favorably to the literature published, where reherniation following limited discectomy has been reported to be 18% at two years. Pain (VAS) and function (ODI) are similar to other published discectomy cohorts.
