Implantation of a bone-anchored annular closure device in conjunction with tubular minimally invasive discectomy for lumbar disc herniation: a retrospective study

BMC Musculoskelet Disord. 2018 Jul 27;19(1):269. doi: 10.1186/s12891-018-2178-4.


Background: Minimally invasive techniques for lumbar discectomy have been recommended as superior to open techniques due to lower blood loss, lower rates of infection and shorter recovery. There are, however, concerns that this approach does not sufficiently remove the herniated nuclear material, thus leaving the patient susceptible to reherniation requiring reoperation. The purpose of this study was to examine the safety and viability of an annular closure device in limiting reherniation and reoperation in a cohort of patients undergoing minimally invasive lumbar discectomy with the assistance of an annular closure device.

Methods: We retrospectively analysed the results from patients treated by a single surgeon between March 2011 and December 2017. All patients had been diagnosed with a large (≥ 5 mm) defect and were treated via minimally invasive surgical techniques. Outcomes included demographic data, the procedural duration and the rates of symptomatic reherniation and reoperation.

Results: 60 patients were included in the study. The mean age was 42 years (range: 19-66); mean BMI was 24.1 (range: 16.7-36.3). Mean surgical duration was 29 min (range: 16-50). Reoperation was required in 5% (3/60) of patients, although only 3% (2/60) experienced symptomatic reherniation at the index level. No other complications were reported.

Conclusions: In our study, the use of an annular closure device during minimally invasive lumbar discectomy in a population of patients with large herniations was associated with low rates of reherniation and reoperation at the index level. While more research is required, the results of this study demonstrate the safety and viability of the annular closure device as an adjunct to minimally invasive discectomy.

Keywords: Annular closure device; Limited discectomy; Lumbar disc herniation; Microscopic discectomy; Minimally invasive; Tubular retractor.

MeSH terms

  • Adult
  • Aged
  • Bone-Anchored Prosthesis*
  • Diskectomy, Percutaneous / adverse effects
  • Diskectomy, Percutaneous / methods*
  • Female
  • Humans
  • Intervertebral Disc / diagnostic imaging
  • Intervertebral Disc / physiopathology
  • Intervertebral Disc / surgery*
  • Intervertebral Disc Displacement / diagnostic imaging
  • Intervertebral Disc Displacement / physiopathology
  • Intervertebral Disc Displacement / surgery*
  • Lumbar Vertebrae / diagnostic imaging
  • Lumbar Vertebrae / physiopathology
  • Lumbar Vertebrae / surgery*
  • Male
  • Microsurgery / adverse effects
  • Microsurgery / methods*
  • Middle Aged
  • Minimally Invasive Surgical Procedures
  • Periodontal Dressings
  • Prosthesis Design
  • Recurrence
  • Reoperation
  • Resins, Synthetic / therapeutic use
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Total Disc Replacement / adverse effects
  • Total Disc Replacement / instrumentation*
  • Treatment Outcome
  • Young Adult


  • Barricaid
  • Resins, Synthetic