Reduction of Recurrent Lumbar Disc Herniation in High Risk Patients – Application of a New Technique. Cantonal Hospital St. Gallen, Switzerland

Aims: Large perforations in the annulus fibrosus are a risk factor for recurrences after surgery for lumbar disc herniation. As a promising device for closing such perforations recently became available, we aimed to evaluate the proportion of patients at risk who are eligible for such an implantation within our population.

Method: Over the 3 months from October to December 2015, we evaluated all patients who underwent surgery for lumbar disc herniation. Inclusion criteria were sciatic pain, disc height more than 5mm and a visible defect intraoperatively. Exclusion criteria were defects which were too small or too large, or those that were too medial or too lateral; osteoporosis; obesity; infection and withheld patient consent. Eligible patients were implanted with the device (Barricaid, Intrinsic). Operating time was recorded.

Results: Fifty-nine patients underwent surgery for a lumbar disc herniation, of whom 13 (22%) met the criteria for the implantation of the annular closure device.

The mean amount of sequester removed was 0.6±ml. Operating time was prolonged by 20± minutes and no implant-related complications were observed. The reasons for non-implantation were (n): the annulus perforation was too small (14), too large (2) or too medial (6); no perforation was visible (7); disc height < 5mm (7); osteoporosis (2); obesity (1); infection (1); the patient refused the implant (1); no consent (1); other (4).

Conclusions: Over a 3 month period, 22% of our patients at high risk of recurrent lumbar disc herniation received the annular closure device according to an established study protocol.

The most frequent reasons for not implanting the device were either too small a perforation, the disc height was too small or the perforation itself was not visible, all factors associated with a low risk of recurrence.