Artikel
Confirming the Carragee massive-defect results: Lumbar discectomy patients at high risk of reherniation
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Autoren
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Adisa Kuršumovic
- DONAUISAR Klinikum Deggendorf, Neurochirurgie, Wirbelsäulenchirurgie und Interventionelle Neuroradiologie, Deutschland
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Frederic Martens
- OLV Ziekenhuis, Department of Neurosurgery, Aalst, Belgium
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Claudius Thomé
- Universitätsklinik für Neurochirurgie, Medizinische Universität Innsbruck, Innsbruck, Österreich
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P. Douglas Klassen
- St. Bonifatius Hospital GmbH, Department of Neurosurgery, Lingen, Deutschland
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Javier Fandino
- Kantonsspital Aarau, Department of Neurosurgery, Aaarau, Schweiz
| Veröffentlicht: | 2. Juni 2015 |
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Gliederung
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Objective: While reported rates of lumbar reherniation vary, in patients with anular defect widths wider than 6mm Carragee et al found the reherniation rate was 27% with all recurrences in this group occurring within the first two and a half years, compared to a 1% rate of reherniation in patients with slit or fissure type defects. Aggressive discectomy may reduce recurrence risk, but less favorable outcomes such as disc collapse, back pain, and accelerated disc degeneration are associated with this technique. Closing massive anular defects after limited discectomy may provide effective treatment in reducing reherniation rates negating the need for aggressive nucleus removal. Measuring anular defect size during discectomy is straightforward, but is not typically performed and is rarely reported in the literature making confirmation of the relative risk level difficult. The current study seeks to confirm the higher risk of reherniation in patients with larger anular defects by comparing the results of the discectomy-only cohort from an ongoing, randomized, post-marketing study of an anular closure device.
Method: Interim data from the control cohort of an ongoing randomized study was reviewed for symptomatic reherniations. Similar to the definition used by Carragee et al to define their ‘massive defect’ group, a key inclusion criterion for the study was an anular defect ≥ 6mm wide (measured intra-operatively). Limited discectomy technique was defined by Spengler. Symptomatic reherniations were reported by the site. Kaplan-Meier survivorship was estimated based on time to symptomatic reherniation, and compared to the data presented by Carragee et al.
Results: 278 patients were enrolled in the discectomy-only cohort. Mean time from surgery was 25.3 months, with a maximum of 45.8 months. Mean volume of nucleus removed was 1.3 cc (0.8 SD). Mean defect width was 8.0 mm. Symptomatic reherniations were observed in 41 patients (14.7%). Kaplan-Meier estimates of survivorship were 86.5% at 18 months and 78.0% at beyond three years, compared to 84% and 76% respectively in Carragee et al.
Conclusions: These interim results from an ongoing study of discectomy patients confirm a high early recurrence risk in patients with large anular defects as predicted by Carragee.
