Risk factors for early reherniation after lumbar discectomy with or without annular closure: results of a multicenter ra
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ORIGINAL ARTICLE - SPINE DEGENERATIVE
Risk factors for early reherniation after lumbar discectomy with or without annular closure: results of a multicenter randomized controlled study Jenny C. Kienzler 1 & Javier Fandino 1 Annular Closure RCT Study Group
&
Erik Van de Kelft 2 & Sandro Eustacchio 3 & Gerrit Joan Bouma 4 & The Barricaid®
Received: 5 April 2020 / Accepted: 17 July 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Background Reherniation after lumbar discectomy is classified as a failure and occurs in 3 to 18% of cases. Various risk factors for reherniation such as age, sex, body mass index, smoking, and size of annular defect have been reported. The aim of this study was to identify risk factors for early reherniation after one-level lumbar discectomy with or without annular closure within 3 months after surgery. Methods This study is based on data analysis of a prospective, multicenter randomized controlled trial in Europe. Patients included underwent standard lumbar discectomy—with or without implantation of an annular closure device (ACD). Enrollment of 554 patients in 21 centers in Europe (Germany, Switzerland, Austria, Belgium, The Netherlands, and France) started in 2010 and was completed in October 2014. A total of 276 patients were randomized to the ACD group (ACG) and 278 patients to the control group (CG). Results Four (1.5%) symptomatic reherniations occurred in the ACG and 18 (6.5%) in the CG. In the overall population, a significant correlation was found with recurrent herniation for disc degeneration (Pfirrmann p = 0.009) and a trend for current smoker status (p = 0.07). In CG, age ≥ 50 years (p = 0.05) and disc degeneration (Pfirrmann p = 0.026, Kellgren and Lawrence p = 0.013) were predictive factors for reherniation. Conclusion In the current study, risk factors for early recurrent disc herniation after lumbar discectomy were age ≥ 50 years and moderate disc degeneration. The annular closure device reduced the risk of early reherniation. Trial registration Clinicaltrials.gov NCT01283438 Keywords Annulus fibrosus . Disc herniation . Annular closure device . Lumbar discectomy . Risk factors . Reherniation
Introduction This article is part of the Topical Collection on Spine degenerative * Javier Fandino [email protected] 1
Department of Neurosurgery, Kantonsspital Aarau, Tellstrasse, 5001 Aarau, Switzerland
2
Department of Neurosurgery, AZ Nikolaas, Sint-Niklaas and Faculty of Medicine and Health Sciences, University of Antwerp, Antwerpen, Belgium
3
Department of Neurosurgery, University Hospital Graz, Graz, Austria
4
Department of Neurosurgery, OLVG Locatie West, Amsterdam, The Netherlands
Lumbar disc herniation is the most common spinal degenerative pathology, and discectomy is the most frequently performed spinal surgery [7, 13, 14]. Reherniation after lumbar discectomy (RLD) is a known frequent failure and has been described extensively in the literature [5, 9, 10, 12, 20, 23, 30, 31, 53]. The reported reherniation rate after lumbar d
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