Department of Neurosurgery, Bonifatius Hospital, Lingen, Germany.
Department of Neurosurgery, OLV Ziekenhuis, Aalst, Belgium.
World Neurosurg. 2019 Oct;130:e926-e932. doi: 10.1016/j.wneu.2019.07.038. Epub 2019 Jul 10.
To determine whether presence of a bone-anchored annular closure device (ACD) impacts reoperation strategies and subsequent outcomes.
Patients with large annular defects after single-level limited lumbar discectomy were randomly allocated to receive an ACD or discectomy alone (controls) and were followed for at least 3 years.
Among 550 patients, reoperation risk was lower with ACD (11.0% vs. 19.3%). The types of reoperations and operative time were similar in each group, and the ACD did not interfere with surgical planning or operative technique. Fusion success was 87% with ACD versus 85% for controls. Perioperative complications occurred in 22% and 19% of reoperations, respectively. Leg pain and back function were improved with ACD versus controls after fusion procedures, and no group differences were observed after non-fusion reoperations.
In patients undergoing post-discectomy reoperation, patients with an ACD were treated with similar operative techniques, were not exposed to additional surgical risks, and reported comparable clinical outcomes versus those without an ACD.
确定骨锚定环形闭合装置（ACD）的存在是否会影响再次手术的策略和后续结果。
将接受单节段有限腰椎间盘切除术的大环形缺陷患者随机分为接受 ACD 或单纯椎间盘切除术（对照组）治疗，并至少随访 3 年。
在 550 例患者中，ACD 组的再手术风险较低（11.0%比 19.3%）。两组的再手术类型和手术时间相似，ACD 不干扰手术计划或手术技术。ACD 组融合成功率为 87%，对照组为 85%。再手术的围手术期并发症发生率分别为 22%和 19%。与对照组相比，ACD 组在融合术后的腿部疼痛和背部功能均有改善，而在非融合再手术中未观察到组间差异。
在接受椎间盘切除术后再次手术的患者中，接受 ACD 治疗的患者采用了类似的手术技术，未面临额外的手术风险，并且报告的临床结果与未接受 ACD 治疗的患者相当。
