gms | German Medical Science

Objective: Microsurgical discectomy is the gold standard treatment for primary lumbar disc herniation patients unresponsive to conservative treatment. Surgeons must decide between aggressive nucleus removal, leading to greater back pain and disc height loss, and conservative nucleus removal, leading to higher reherniation rates. Anular closure devices, which seal the anular defect found or created during surgery, may allow for minimal nucleus removal with reduced reherniation risk. The Barricaid Prosthesis consists of a flexible mesh intended to block an anular defect while anchored to an adjacent vertebral body by a bone anchor.

Method: 141 patients have been treated with the Barricaid since September 2009. ODI, back, and leg VAS were completed pre-operatively, and at each follow-up. Clinical exams, standing, and functional x-rays were assessed at each time-point, with MRs taken at 12 months. Reherniations and device integrity were noted.

Results: Mean patient age was 46.1 years with an average anular defect size of 40.2 mm2. Five symptomatic reherniations have occurred (3.6%), with one additional asymptomatic reherniation. Four mesh dislocations have occurred, two in patients whose defect was larger than allowed for the size of mesh that was implanted. Outcomes were available for 122 patients with an average follow-up of 329.7 days (range 0–791). Comparing average scores at pre-op vs. latest follow-up, decreases in ODI from 53.4 pre-op to 18.9, back pain from 60.7 pre-op to 29.1, and leg pain from 78.8 pre-op to 27.2 were noted.

Conclusions: The symptomatic reherniation rate of 3.6% among these patients who are an average of 25.6 months post-op compares favorably to literature, where reherniation following limited discectomy has been reported to be as high as 18% at two years. Outcomes are similar to other published discectomy cohorts.