Introduction: Reherniation after lumbar microdiscectomy remains a common failure, despite the procedure having been performed for over a century. Failure rates are particularly high in patients with larger annular defects. Multiple studies have shown the effectiveness of bone-anchored annular closure in reducing the incidence of reherniation and all-cause reoperation after lumbar discectomy in these patients. The purpose of this study was to describe the types and frequency of intra-operative complications associated with implantation of bone-anchored annular closure devices.
Methods: Sites enrolled up to 10 consecutive lumbar discectomy patients each in a prospectively planned registry. Intra-operatively, following the completion of the discectomy, the resulting annular defect (if any) was measured to determine the clinical need and eligibility for implanting a bone-anchored annular closure device (Barricaid®; Woburn, MA, USA). For eligible patients, success of implantation as well as any complications or challenges were recorded.
Results: A total of 608 patients were enrolled by 90 investigators, 242 (40%) of whom were found intra-operatively to have large annular defects of a size eligible to receive the Barricaid implant. Seven (2.9%) patients who were eligible to receive the Barricaid were not implanted (2 immobile nerve root, 1 dense bone, 2 more bone removal required, 1 removed after implantation due to looseness, 1 unknown). An additional 15 (6.2%) patients were successfully implanted, but with an additional challenge or complication noted (2 extra bone removal required, 1 instrument failure, 5 difficulty using instrument, 7 implant access). No dural tears or nerve damage was reported.
Conclusion : Bone-anchored annular closure is an increasingly common approach to reducing the incidence of reherniation following lumbar discectomy in patients at the highest risk. In this multi-center prospective registry, the proportion of patients with defects large enough to be at particularly high risk of reherniation (40%) matched prior literature reports. More than 97% of these patients were successfully treated with bone-anchored annular closure, and complications were limited.
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