Prospective cohort study.
Evaluate if an annular closure device could be implanted safely, reduce same-level recurrent disc herniation, or attenuate disc height loss and improve outcome after lumbar discectomy.
Same-level recurrent disc herniation, disc height loss, and progressive degeneration are common complications and sequellae after lumbar discectomy. Techniques to reduce these consequences may improve outcomes.
Forty-six consecutive patients undergoing lumbar discectomy for single-level herniated disc at two institutions were prospectively followed with clinical and radiographic evaluations at 6 weeks and 3, 6, 12 and 24 months (control cohort). A second consecutive cohort of 30 patients undergoing 31 lumbar discectomies with implantation of an annular closure device was similarly followed. Incidence of recurrent disc herniation, disc height loss, leg and back pain visual analogue scale (VAS) and Oswestry Disability Index (ODI) were assessed at each follow-up.
Cohorts were well matched at baseline. By two-years follow-up, symptomatic recurrent same-level disc herniation occurred in 3(6.5%) patients in the control cohort versus 0(0%) patients in the annular repair cohort (P=0.27). A trend of greater preservation of disc height was observed in the annular repair versus control cohort three months (7.9 vs. 7.27 mm, P=0.08), six months (7.81 vs. 7.18 mm, P=0.09), and twelve months post-operatively (7.63 vs. 6.9 mm, P=0.06). Annular closure cohort reported less leg pain (VAS-LP: 5 vs. 16, P<0.01), back pain (VAS-BP: 13 vs. 22, P<0.05), and disability (ODI: 16 vs. 22, P<0.05) one-year post-operatively.
Implantation of a novel annular repair device was associated with greater maintenance of disc height and improved one-year leg pain, back pain, and low-back disability. Recurrent disc herniation did not occur in any patients after annular repair. Closure of annular defect after lumbar discectomy may help preserve physiologic disc function and prevent long-term disc height loss and associated back and leg pain.