gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Can lumbar discectomy with the Barricaid endoprosthesis bring benefit to patients with back pain greater than leg pain?

Meeting Abstract

  • G.J. Bouma - Sint Lucas Andreas Ziekenhuis, Spine Center, Amsterdam, Netherlands
  • M. Barth - Neurochirurgiche Klinik, Universität Mannheim, Germany
  • M. Vilendecic - University Hospital Dubrava, Zagreb, Croatia
  • D. Ledic - University Hospital, Rijeka, Croatia
  • R. Bartels - CWZ Department of Neurosurgery Nijmegen, Netherlands
  • E.A. Al-Kahlout - Klinikum Duisburg GmbH, Duisburg, Germany

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocSA.08.05

DOI: 10.3205/12dgnc356, URN: urn:nbn:de:0183-12dgnc3568

Published: June 4, 2012

© 2012 Bouma et al.
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Outline

Text

Objective: Higher levels of pre-op back pain relative to leg pain in patients with lumbar disc herniation have been linked to worse outcomes following discectomy [1]. Some advocate lowering expectations for discectomy outcomes or using a more invasive and expensive procedure such as fusion in this difficult patient population. This investigation was to determine if there is a link between higher pre-operative back pain and worse outcomes in patients treated with lumbar discectomy with defect closure using the Barricaid endoprosthesis.

Methods: The Barricaid partial disc endoprosthesis has been evaluated in two prospective, single-arm, multi-center studies in Germany, the Netherlands, and Croatia involving 75 primary discectomy patients with a mean follow-up of 18.2 months. Pre-op, 15/75 (20%) patients had worse VAS back pain than leg pain. The results at 1 and 2 years for this group (BP) were compared to the remaining patients with predominant pre-op leg pain (LP) using patient reported outcome instruments including VAS leg, VAS back, and ODI.

Results: Worse back pain pre-op did not correlate with worse outcomes at 1 and 2 years, with both BP and LP groups improving dramatically in all outcomes. At 2 years the BP group had superior results, although not statistically significant. Pre-op, the VAS Leg, VAS Back, and ODI for the two groups were BP Leg: 69/100 vs. LP Leg: 84/100 (p<0.01), BP Back: 82/100 vs. LP Back: 56/100 (p<0.01) and BP ODI: 61/100 vs. LP ODI: 61/100 (p=0.96). At 1 year, the outcomes for the two groups were BP Leg: 15/100 vs. LP Leg: 11/100 (p=0.97), BP Back: 21/100 vs. LP Back: 20/100 (p=0.63) and BP ODI: 17/100 vs. LP ODI: 16/100 (p=0.81). At 2 years, the outcomes were BP Leg: 3/100 vs. LP Leg: 15/100 (p=0.37), BP Back: 4 / 100 vs. LP Back: 15/100 (p=0.14) and BP ODI: 7/100 vs. LP ODI: 14/100 (p=0.52).

Conclusions: In contrary to previously reported results from standard lumbar discectomy, patients treated with discectomy and Barricaid in this study showed no correlation between high pre-operative back pain and worse outcomes. One possible explanation is that closing the anular defect may provide benefits that positively influence patient outcome beyond simply preventing recurrent disc herniation. These preliminary results using the Barricaid endoprosthesis in this difficult population with predominant back pain are promising and deserve further investigation.


References

1.
Kleinstueck FS, Fekete T, Jeszenszky D, Mannion AF, Grob D, Lattig F, Mutter U, Porchet F. The outcome of decompression surgery for lumbar herniated disc is influenced by the level of concomitant preoperative low back pain. Eur Spine J. 2011 Jul;20(7):1166-73. DOI: 10.1007/s00586-010-1670-9 External link