Department for Traumatology and Orthopaedics, Section for Spine Surgery, Klinikum Itzehoe, Itzehoe, Germany.
Miller Scientific Consulting, Asheville, North Carolina, USA.
Orthop Surg. 2019 Jun;11(3):431-437. doi: 10.1111/os.12495.
To examine the results of an anular closure device for prevention of lumbar disc reherniation in daily routine practice.
Fifty patients with large anular defects were treated with limited discectomy and a bone-anchored anular closure device. The device physically occludes the defect in the anulus fibrosus and is intended for prevention of lumbar disc reherniation. Pain scores on a visual analogue scale, back function on the Oswestry Disability Index, and neurological status were noted. Symptomatic reherniation and reoperation rates were assessed at each follow-up. Surgical findings and complications, device-related and/or procedure-related, were recorded. Follow-up was 6, 12, 26, and 52 weeks.
Mean anular defect height/width was 4.6 mm/10.1 mm. The overall symptomatic reherniation and reoperation rate was 2%. During the 1-year follow-up period, mean back pain decreased from 43 to 8 (P < 0.001), leg pain decreased from 71 to 4 (P < 0.001), and the Oswestry Disability Index decreased from 46 to 5 (P < 0.001). Among 15 patients with preoperative neurological deficits, improvements in neurological function were noted in 14 (93%). There were no serious device-related complications.
The presented study shows promising early results in using the anular closure device. The procedure is safe with significantly fewer reherniations than for patients with large anular defects without anular closure. Further studies with longer follow-up periods are warranted to prove these findings for long-term outcomes.
研究一种用于预防腰椎间盘再突出的环形封闭装置在日常实践中的结果。
50 例大环形缺陷患者接受有限椎间盘切除术和骨锚定环形封闭装置治疗。该装置物理性地封闭纤维环的缺陷，旨在预防腰椎间盘再突出。记录视觉模拟评分的疼痛评分、Oswestry 残疾指数的背部功能以及神经状态。在每次随访时评估症状性再突出和再手术率。记录手术发现和并发症，包括与器械相关和/或与手术相关的并发症。随访时间为 6、12、26 和 52 周。
平均环形缺陷高度/宽度为 4.6mm/10.1mm。总的症状性再突出和再手术率为 2%。在 1 年的随访期间，背部疼痛平均值从 43 分降至 8 分（P<0.001），腿部疼痛从 71 分降至 4 分（P<0.001），Oswestry 残疾指数从 46 分降至 5 分（P<0.001）。在 15 例术前存在神经功能缺损的患者中，14 例（93%）的神经功能得到改善。没有严重的器械相关并发症。
本研究显示使用环形封闭装置具有早期有希望的结果。与没有环形封闭的大环形缺陷患者相比，该手术安全，再突出率显著降低。需要进行更长时间的随访研究以证明这些发现的长期结果。
