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Protecting Facet Joints Post-Lumbar Discectomy: Barricaid Annular Closure Device Reduces Risk of Facet Degeneration

Clin Neurol Neurosurg. 2013 Aug;115(8):1440-5
AUTHORS:
M Trummer1, S Eustacchio, M Barth, PD Klassen, S Stein
1 Medical University, Graz, Austria

ABSTRACT

PURPOSE

Effect of Barricaid on facet degeneration one year following discectomy

OBJECT

Facet joint degeneration after discectomy may be the result of excessive nuclear removal, disc space narrowing, and annular injury.  This study investigated whether implantation with the Barricaid Annular Closure Device (ACD) during discectomy reduced the rate of facet degeneration.

METHODS

Inclusion criteria were primary lumbar disc herniation failing conservative treatment, Visual Analog Scale (VAS) Leg ≥ 40/100, Oswestry Disability Index (ODI) ≥ 40/100 and defects that were ≤ 60 mm2(Barricaid arm only), and patient age 18-75.  CT interpretations were collected preoperatively and 12 months post-discectomy.  Paired preoperative and 12 month follow-up CT Scans were available for 94 Discectomy-only patients and 63 Barricaid patients.  Grading was performed by a single radiologist, per the four-point scale of Pathria et al (1987).

SELECT RESULTS

Defining facet degeneration as an increase of at least one grade on the four-point scale, at 12 months the discectomy-only group had a significantly higher rate of facet degeneration than the Barricaid group (43% vs. 24%; p=0.015, Fisher’s Exact). 

CONCLUSIONS

ACDs may be able to maintain disc space height and reduce facet degeneration by minimizing the amount of nuclear material that is removed during disectomy.  Our findings support this theory and suggest that implantation with the Barricaid during discectomy has significant benefits in disc space maintenance and facet degeneration risk.  The fact that none of the clinical outcome scores demonstrated statistically significant benefits from Barricaid implantation emphasizes the need for longer follow-up studies in the future.

KEYWORDS

Annular closure device; Annulus fibrosis; Disc herniation; Discectomy; Facet arthrosis; Facet degeneration; Facet joint; Lumbar