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DISCECTOMY DILEMMA

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The Barricaid® device, designed to close large defects in the anulus, allows surgeons to walk away from having to perform an aggressive discectomy in patients at high risk of recurrent herniation.

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Until the availability of anular closure technology, surgeons had only one option to reduce the risk of recurrent herniation in these larger defect patients – aggressive removal of the remaining nucleus. While this technique is effective at decreasing the risk of reherniation, it comes at the cost of disc collapse and significantly worse clinical outcomes over time1.

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The Barricaid allows surgeons to perform a limited nucleotomy in every patient, by offering a secure closure to those present with a large defect. Being able to effectively close large defects, the surgeon can now opt to preserve more of the patient’s disc, without increasing the risk of a recurrent disc herniation.

 

1 Watters at al. 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. (2009) Mar;9(3):240-57. 46.
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A SURGEON'S PERSPECTIVE

Dr. Joshua M. Ammerman is a board-certified neurosurgeon at Washington Neurosurgical Associates. and Chief of the Neurosurgery Section and Chair of the Department of Surgery at Sibley Memorial Hospital.  In this video Dr. Ammerman describes the dilemma faced by surgeons performing lumbar discectomy. Lumbar disc herniation is one of the most common indications for spinal surgery, and yet the outcomes are far from perfect.


2 Carragee, et al. Clinical Outcomes After Lumbar Discectomy for Sciatica: The Effects of Fragment Type and Anular Comptence.J Bone Joint Surg Am. (2003) Jan;85-A(1):102-8.
3 McGirt et al. Recurrent Disc Herniation And Long-Term Back Pain After Primary Lumbar Discectomy: Review Of Outcomes Reported For Limited Versus Aggressive Disc Removal. Neurosurgery (2009) Feb;64(2):338-44; discussion 344-5.
4 Kim at al. Preoperative Risk Factors for Recurrent Lumbar DiskHerniation in L5–S1. J Spinal Disord Tech Volume 28, Number 10, December 2015