Annular closure device breakage due to recurrent lumbar disc herniation: a case report
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CASE REPORT - SPINE - OTHER
Annular closure device breakage due to recurrent lumbar disc herniation: a case report Benedikt W. Burkhardt 1,2 & Joachim M. Oertel 1 Received: 9 September 2020 / Accepted: 12 November 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Detailed surgical management, magnetic resonance imaging (MRI), and computer tomography (CT) images of a broken annular closure device (ACD) have not been reported yet. In this case, a 28-year-old male presented with a new onset of radiculopathy three years after lumbar discectomy and placement of an ACD. The CT-myelography and MRI revealed a recurrent disc herniation (RDH) and dislocation of a broken ACD. ACD removal was performed and confirmed breakage due to RDH with scarring around the RDH and displaced ACD. Implant-associated complications and management should be reported in detail in order to enhance knowledge on device-related complications. Keywords Annuloplasty . Annular closure device . Barricaid . Breakage . Complication . Recurrent disc herniation
Background Microsurgical lumbar discectomy (MLD) is a standardized procedure for the treatment of sciatica caused by lumbar disc herniation (LDH). Long-term follow-up studies have demonstrated that MLD offers a high rate of clinical success [4, 5]. However, several drawbacks following MLD have been reported such as a rate of recurrent disc herniation (RDH), which varies between 5 and 15%, loss of disc height, and progressive degeneration of the facet joints [7, 13]. Reoperation for RDH
This article is part of the Topical Collection on Spine - Other * Benedikt W. Burkhardt [email protected] 1
Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Saar, Germany
2
Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrbergerstrasse 100 Gebäude 90.5, 66421 Homburg, Saar, Germany
is challenging since it is associated with higher rate of complication, and lower rate of clinical success than primary MLD procedures [1, 8]. The risk of reoperation for RDH is higher in patients with larger annular defect width [15]. An annular closure device (ACD) has been developed to reduce the risk of RDH [12]. The ACD consists of a flexible polymer occlusion component, which closes the annular defect. This flexible component attaches to a titanium alloy bone anchor, which is driven into the adjacent vertebral body to secure the correct poisoning of the ACD. A multicenter randomized trial was conducted to determine the effectiveness of additional placement of a ACD to lower the risk of RDH and reoperation in patients with large annular defects following MLD. According to a meta-analysis performed by Miller et al., the risk of reoperation for RDH following implantation of an ACD is 7.7% within two years of follow-up and therefore 48% lower compared to 14.5% following conventional MLD [14]. However, literature body of detailed descriptions of device-rel
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