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Research article
Jenny Christine Kienzler
Corresponding Author
ORCiD: https://orcid.org/0000-0003-2480-0451
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Background: An annular closure device (ACD) could potentially prevent recurrent herniation by blocking larger annular defects after limited microdiscectomy (LMD). The purpose of this study was to analyze the incidence of endplate changes (EPC) and outcome after LMD with additional implantation of an ACD to prevent reherniation.
Methods: This analysis includes data from a) RCT study-arm of patients undergoing LMD with ACD implantation and b) additional patients undergoing ACD implantation at our institution. Clinical findings (VAS,ODI), radiological outcome (reherniation, implant integrity, volume of (EPC) and risk factors for EPC were assessed.
Results: Seventy-two patients (37men, 47±11.63yo) underwent LMD and ACD implantation between 2013-2016. A total of 71 (99%) patients presented with some degree of EPC during the follow-up period (14.67±4.77months). In the multivariate regression analysis, localization of the anchor was the only significant predictor of EPC (p=0.038). The largest EPC measured 4.2 cm3. Reherniation was documented in 17 (24%) patients (symptomatic: n=10; asymptomatic: n=7). Six (8.3%) patients with symptomatic reherniation underwent rediscectomy. Implant failure was documented in 19 (26.4%) patients including anchor head breakage (n=1, 1.3%), dislocation of the whole device (n=5, 6.9%), and mesh dislocation into the spinal canal (n=13, 18%). Mesh subsidence within the EPC was documented in 15 (20.8%) patients. Seven (9.7%) patients underwent explantation of the entire, or parts of the device.
Conclusion: Clinical improvement after LMD and ACD implantation was proven in our study. High incidence and volume of EPC did not correlate with clinical outcome. The ACD might prevent disc reherniation despite implant failure rates. Mechanical friction of the polymer mesh with the endplate is most likely the cause of EPC after ACD.
Keywords
disc herniation, reherniation, endplate changes, annular closure device, Barricaid®
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Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Surgery.
Version 2
Posted 18 Nov, 2020
No community comments so far
Editorial decision: Accept
On 13 Dec, 2020
Review #1 received
Received 09 Dec, 2020
Reviewers invited
Invitations sent on 01 Dec, 2020
Reviewer #1 agreed
On 01 Dec, 2020
Editor assigned
On 08 Nov, 2020
Submission checks complete
On 08 Nov, 2020
Editor invited
On 08 Nov, 2020
No comments provided
Editorial decision: Minor revision
On 02 Nov, 2020
Review #1 received
Received 07 Sep, 2020
Review #2 received
Received 26 Aug, 2020
Reviewer #2 agreed
On 24 Aug, 2020
Reviewers invited
Invitations sent on 21 Aug, 2020
Reviewer #1 agreed
On 21 Aug, 2020
Editor assigned
On 10 Aug, 2020
Submission checks complete
On 09 Aug, 2020
Editor invited
On 09 Aug, 2020
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HTML Views: ...
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A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
See the published version of this preprint at BMC Surgery.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Jenny Christine Kienzler
Corresponding Author
ORCiD: https://orcid.org/0000-0003-2480-0451
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Surgery.
Version 2
Posted 18 Nov, 2020
No community comments so far
Editorial decision: Accept
On 13 Dec, 2020
Review #1 received
Received 09 Dec, 2020
Reviewers invited
Invitations sent on 01 Dec, 2020
Reviewer #1 agreed
On 01 Dec, 2020
Editor assigned
On 08 Nov, 2020
Submission checks complete
On 08 Nov, 2020
Editor invited
On 08 Nov, 2020
No comments provided
Editorial decision: Minor revision
On 02 Nov, 2020
Review #1 received
Received 07 Sep, 2020
Review #2 received
Received 26 Aug, 2020
Reviewer #2 agreed
On 24 Aug, 2020
Reviewers invited
Invitations sent on 21 Aug, 2020
Reviewer #1 agreed
On 21 Aug, 2020
Editor assigned
On 10 Aug, 2020
Submission checks complete
On 09 Aug, 2020
Editor invited
On 09 Aug, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Surgery.
Background: An annular closure device (ACD) could potentially prevent recurrent herniation by blocking larger annular defects after limited microdiscectomy (LMD). The purpose of this study was to analyze the incidence of endplate changes (EPC) and outcome after LMD with additional implantation of an ACD to prevent reherniation.
Methods: This analysis includes data from a) RCT study-arm of patients undergoing LMD with ACD implantation and b) additional patients undergoing ACD implantation at our institution. Clinical findings (VAS,ODI), radiological outcome (reherniation, implant integrity, volume of (EPC) and risk factors for EPC were assessed.
Results: Seventy-two patients (37men, 47±11.63yo) underwent LMD and ACD implantation between 2013-2016. A total of 71 (99%) patients presented with some degree of EPC during the follow-up period (14.67±4.77months). In the multivariate regression analysis, localization of the anchor was the only significant predictor of EPC (p=0.038). The largest EPC measured 4.2 cm3. Reherniation was documented in 17 (24%) patients (symptomatic: n=10; asymptomatic: n=7). Six (8.3%) patients with symptomatic reherniation underwent rediscectomy. Implant failure was documented in 19 (26.4%) patients including anchor head breakage (n=1, 1.3%), dislocation of the whole device (n=5, 6.9%), and mesh dislocation into the spinal canal (n=13, 18%). Mesh subsidence within the EPC was documented in 15 (20.8%) patients. Seven (9.7%) patients underwent explantation of the entire, or parts of the device.
Conclusion: Clinical improvement after LMD and ACD implantation was proven in our study. High incidence and volume of EPC did not correlate with clinical outcome. The ACD might prevent disc reherniation despite implant failure rates. Mechanical friction of the polymer mesh with the endplate is most likely the cause of EPC after ACD.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7
Figure 8
Figure 9
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