Jenny C Kienzler1, Javier Fandino2, Erik Van de Kelft3, Sandro Eustacchio4, Gerrit Joan Bouma5. 1. Department of Neurosurgery, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland. 2. Department of Neurosurgery, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland. fandino@neurochirurgie-ag.ch. 3. Department of Neurosurgery, AZ Nikolaas, Sint-Niklaas and Faculty of Medicine and Health Sciences, University of Antwerp, Antwerpen, Belgium. 4. Department of Neurosurgery, University Hospital Graz, Graz, Austria. 5. Department of Neurosurgery, OLVG Locatie West, Amsterdam, The Netherlands.
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.
RCT Entities:
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.
Authors: Giannina L Garcés Ambrossi; Matthew J McGirt; Daniel M Sciubba; Timothy F Witham; Jean-Paul Wolinsky; Ziya L Gokaslan; Donlin M Long Journal: Neurosurgery Date: 2009-09 Impact factor: 4.654