Focus of the Report: This report focuses on annular closure for the prevention of recurrent lumbar disc herniation (LDH) after lumbar discectomy (LD).

Technology Description: Annular closure is a surgical treatment that is performed immediately following an LDH debridement surgery (e.g., lumbar discectomy, sequestrectomy, nucleotomy). The annular closure surgical procedure involves the implantation of a device to mimic healthy annulus fibrosus at the site of the annular defect in order to aid recovery and prevent future reherniation. The Barricaid annular closure device is currently the only Food and Drug Administration (FDA) approved method of annular closure that is available. The Barricaid annular closure device (ACD) is a U-shaped bone-anchored implantable device comprising a jagged titanium wing and a woven polyester fabric occlusion component. The ACD is implanted such that the occlusion component fills the void of the annular defect, and the titanium alloy arm anchors the ACD onto the adjacent vertebral body.

Controversy: LD is the standard surgery utilized to treat symptomatic LDH that is refractory to treatment with conservative care. While LD is an effective method of achieving symptom relief, it does not address the etiological cause of LDH, and leaves patients prone to recurrent LDH at the same weakened annular defect. Annular closure involves the insertion of a bone-anchored device into the annular defect to help contain the nucleus pulposus and reinforce the weakened annulus fibrosus, which could reduce postoperative recurrence and complications that are observed after stand-alone LD (Choy et al., 2018; Ammerman et al., 2019).

Key Questions:

  • Is annular closure an effective adjunct to lumbar discectomy (LD) for improving radiculopathy and preventing lumbar disc reherniation (LDH)?

  • How does adjunctive annular closure device (ACD) implantation surgery compare with traditional LDH surgical interventions performed without annular closure?

  • Is annular closure a safe adjunct to LD alone?

  • Have definitive patient selection criteria for annular closure been established?

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