Top

Published in:

01-01-2021 | Disc Herniation | Original Article - Spine degenerative

Risk factors for early reherniation after lumbar discectomy with or without annular closure: results of a multicenter randomized controlled study

Authors: Jenny C. Kienzler, Javier Fandino, Erik Van de Kelft, Sandro Eustacchio, Gerrit Joan Bouma, The Barricaid® Annular Closure RCT Study Group

Published in: Acta Neurochirurgica | Issue 1/2021

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

Abrishamkar S, Mahmoudkhani M, Aminmansour B, Mahabadi A, Jafari S (2014) Does disk space degeneration according to Los Angeles and Modic scales have relation with recurrent disk herniation? Adv Biomed Res 3:220. https://doi.org/10.4103/2277-9175.145125CrossRefPubMedPubMedCentral

Aizawa T, Ozawa H, Kusakabe T, Nakamura T, Sekiguchi A, Takahashi A, Sasaji T, Tokunaga S, Chiba T, Morozumi N, Koizumi Y, Itoi E (2012) Reoperation for recurrent lumbar disc herniation: a study over a 20-year period in a Japanese population. J Orthop Sci 17:107–113. https://doi.org/10.1007/s00776-011-0184-6CrossRefPubMed

Ambrossi GL, McGirt MJ, Sciubba DM, Witham TF, Wolinsky JP, Gokaslan ZL, Long DM (2009) Recurrent lumbar disc herniation after single-level lumbar discectomy: incidence and health care cost analysis. Neurosurgery 65:574–578; discussion 578. https://doi.org/10.1227/01.NEU.0000350224.36213.F9CrossRefPubMed

An HS, Silveri CP, Simpson JM, File P, Simmons C, Simeone FA, Balderston RA (1994) Comparison of smoking habits between patients with surgically confirmed herniated lumbar and cervical disc disease and controls. J Spinal Disord 7:369–373CrossRefPubMed

Atlas SJ, Keller RB, Wu YA, Deyo RA, Singer DE (2005) Long-term outcomes of surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: 10 year results from the maine lumbar spine study. Spine (Phila Pa 1976) 30:927–935. https://doi.org/10.1097/01.brs.0000158954.68522.2aCrossRef

Bouma GJ, Barth M, Ledic D, Vilendecic M (2013) The high-risk discectomy patient: prevention of reherniation in patients with large anular defects using an anular closure device. Eur Spine J 22:1030–1036. https://doi.org/10.1007/s00586-013-2656-1CrossRefPubMedPubMedCentral

Bruske-Hohlfeld I, Merritt JL, Onofrio BM, Stonnington HH, Offord KP, Bergstralh EJ, Beard CM, Melton LJ 3rd, Kurland LT (1990) Incidence of lumbar disc surgery. A population-based study in Olmsted County, Minnesota, 1950-1979. Spine (Phila Pa 1976) 15:31–35. https://doi.org/10.1097/00007632-199001000-00009CrossRef

Carragee EJ, Han MY, Suen PW, Kim D (2003) Clinical outcomes after lumbar discectomy for sciatica: the effects of fragment type and anular competence. J Bone Joint Surg Am 85:102–108CrossRefPubMed

Carragee EJ, Spinnickie AO, Alamin TF, Paragioudakis S (2006) A prospective controlled study of limited versus subtotal posterior discectomy: short-term outcomes in patients with herniated lumbar intervertebral discs and large posterior anular defect. Spine (Phila Pa 1976) 31:653–657. https://doi.org/10.1097/01.brs.0000203714.76250.68CrossRef

10.

Cauchoix J, Ficat C, Girard B (1978) Repeat surgery after disc excision. Spine (Phila Pa 1976) 3:256–259. https://doi.org/10.1097/00007632-197809000-00011CrossRef

11.

Dora C, Schmid MR, Elfering A, Zanetti M, Hodler J, Boos N (2005) Lumbar disk herniation: do MR imaging findings predict recurrence after surgical diskectomy? Radiology 235:562–567. https://doi.org/10.1148/radiol.2352040624CrossRefPubMed

12.

Findlay GF (1992) Minimally invasive lumbar disc surgery. Br J Neurosurg 6:405–408. https://doi.org/10.3109/02688699208995028CrossRefPubMed

13.

Frymoyer JW (1992) Lumbar disk disease: epidemiology. Instr Course Lect 41:217–223PubMed

14.

Gray DT, Deyo RA, Kreuter W, Mirza SK, Heagerty PJ, Comstock BA, Chan L (2006) Population-based trends in volumes and rates of ambulatory lumbar spine surgery. Spine (Phila Pa 1976) 31:1957–1963; discussion 1964. https://doi.org/10.1097/01.brs.0000229148.63418.c1CrossRef

15.

Grevitt M, Khazim R, Webb J, Mulholland R, Shepperd J (1997) The short form-36 health survey questionnaire in spine surgery. J Bone Joint Surg Br 79:48–52. https://doi.org/10.1302/0301-620x.79b1.1269CrossRefPubMed

16.

Hampton D, Laros G, McCarron R, Franks D (1989) Healing potential of the anulus fibrosus. Spine (Phila Pa 1976) 14:398–401. https://doi.org/10.1097/00007632-198904000-00009CrossRef

17.

Holm S, Nachemson A (1988) Nutrition of the intervertebral disc: acute effects of cigarette smoking. An experimental animal study. Ups J Med Sci 93:91–99. https://doi.org/10.1517/03009734000000042CrossRefPubMed

18.

Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502. https://doi.org/10.1136/ard.16.4.494CrossRefPubMedPubMedCentral

19.

Kelsey JL, Githens PB, O'Conner T, Weil U, Calogero JA, Holford TR, White AA 3rd, Walter SD, Ostfeld AM, Southwick WO (1984) Acute prolapsed lumbar intervertebral disc. An epidemiologic study with special reference to driving automobiles and cigarette smoking. Spine (Phila Pa 1976) 9:608–613. https://doi.org/10.1097/00007632-198409000-00012CrossRef

20.

Keskimaki I, Seitsalo S, Osterman H, Rissanen P (2000) Reoperations after lumbar disc surgery: a population-based study of regional and interspecialty variations. Spine (Phila Pa 1976) 25:1500–1508. https://doi.org/10.1097/00007632-200006150-00008CrossRef

21.

Kienzler JC, Klassen PD, Miller LE, Assaker R, Heidecke V, Frohlich S, Thome C, Annular Closure RCTSG (2019) Three-year results from a randomized trial of lumbar discectomy with annulus fibrosus occlusion in patients at high risk for reherniation. Acta Neurochir 161:1389–1396. https://doi.org/10.1007/s00701-019-03948-8CrossRefPubMed

22.

Kim CH, Chung CK, Park CS, Choi B, Hahn S, Kim MJ, Lee KS, Park BJ (2013) Reoperation rate after surgery for lumbar spinal stenosis without spondylolisthesis: a nationwide cohort study. Spine J 13:1230–1237. https://doi.org/10.1016/j.spinee.2013.06.069CrossRefPubMed

23.

Kim CH, Chung CK, Park CS, Choi B, Kim MJ, Park BJ (2013) Reoperation rate after surgery for lumbar herniated intervertebral disc disease: nationwide cohort study. Spine (Phila Pa 1976) 38:581–590. https://doi.org/10.1097/BRS.0b013e318274f9a7CrossRef

24.

Kim JM, Lee SH, Ahn Y, Yoon DH, Lee CD, Lim ST (2007) Recurrence after successful percutaneous endoscopic lumbar discectomy. Minim Invasive Neurosurg 50:82–85. https://doi.org/10.1055/s-2007-982504CrossRefPubMed

25.

Kim KT, Lee DH, Cho DC, Sung JK, Kim YB (2015) Preoperative risk factors for recurrent lumbar disk herniation in L5-S1. J Spinal Disord Tech 28:E571–E577. https://doi.org/10.1097/BSD.0000000000000041CrossRefPubMed

26.

Kim KT, Park SW, Kim YB (2009) Disc height and segmental motion as risk factors for recurrent lumbar disc herniation. Spine (Phila Pa 1976) 34:2674–2678. https://doi.org/10.1097/BRS.0b013e3181b4aaacCrossRef

27.

Klassen PDHGJ, Bouma S, Eustacchio M, Barth M, Kursumovic A et al (2016) A multicenter, prospective, randomized study protocol to demonstrate the superiority of a bone-anchored prosthesis for anular closure used in conjunction with limited discectomy to limited discectomy alone for primary lumbar disc herniation. Int J Clin Trials 3(3):120–131CrossRef

28.

Kuri M, Nakagawa M, Tanaka H, Hasuo S, Kishi Y (2005) Determination of the duration of preoperative smoking cessation to improve wound healing after head and neck surgery. Anesthesiology 102:892–896. https://doi.org/10.1097/00000542-200505000-00005CrossRefPubMed

29.

Little CP, Burston BJ, Hopkinson-Woolley J, Burge P (2006) Failure of surgery for scaphoid non-union is associated with smoking. J Hand Surg Br 31:252–255. https://doi.org/10.1016/j.jhsb.2005.12.010CrossRefPubMed

30.

Malter AD, McNeney B, Loeser JD, Deyo RA (1998) 5-year reoperation rates after different types of lumbar spine surgery. Spine (Phila Pa 1976) 23:814–820. https://doi.org/10.1097/00007632-199804010-00015CrossRef

31.

Martin BI, Mirza SK, Flum DR, Wickizer TM, Heagerty PJ, Lenkoski AF, Deyo RA (2012) Repeat surgery after lumbar decompression for herniated disc: the quality implications of hospital and surgeon variation. Spine J 12:89–97. https://doi.org/10.1016/j.spinee.2011.11.010CrossRefPubMed

32.

McGirt MJ, Eustacchio S, Varga P, Vilendecic M, Trummer M, Gorensek M, Ledic D, Carragee EJ (2009) A prospective cohort study of close interval computed tomography and magnetic resonance imaging after primary lumbar discectomy: factors associated with recurrent disc herniation and disc height loss. Spine (Phila Pa 1976) 34:2044–2051. https://doi.org/10.1097/BRS.0b013e3181b34a9aCrossRef

33.

Meredith DS, Huang RC, Nguyen J, Lyman S (2010) Obesity increases the risk of recurrent herniated nucleus pulposus after lumbar microdiscectomy. Spine J 10:575–580. https://doi.org/10.1016/j.spinee.2010.02.021CrossRefPubMed

34.

Miwa S, Yokogawa A, Kobayashi T, Nishimura T, Igarashi K, Inatani H, Tsuchiya H (2015) Risk factors of recurrent lumbar disk herniation: a single center study and review of the literature. J Spinal Disord Tech 28:E265–E269. https://doi.org/10.1097/BSD.0b013e31828215b3CrossRefPubMed

35.

Moliterno JA, Knopman J, Parikh K, Cohan JN, Huang QD, Aaker GD, Grivoyannis AD, Patel AR, Hartl R, Boockvar JA (2010) Results and risk factors for recurrence following single-level tubular lumbar microdiscectomy. J Neurosurg Spine 12:680–686. https://doi.org/10.3171/2009.12.SPINE08843CrossRefPubMed

36.

Moller AM, Pedersen T, Villebro N, Munksgaard A (2003) Effect of smoking on early complications after elective orthopaedic surgery. J Bone Joint Surg Br 85:178–181. https://doi.org/10.1302/0301-620x.85b2.13717CrossRefPubMed

37.

Patrick DL, Deyo RA, Atlas SJ, Singer DE, Chapin A, Keller RB (1995) Assessing health-related quality of life in patients with sciatica. Spine (Phila Pa 1976) 20:1899–1908; discussion 1909. https://doi.org/10.1097/00007632-199509000-00011CrossRef

38.

Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N (2001) Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976) 26:1873–1878. https://doi.org/10.1097/00007632-200109010-00011CrossRef

39.

Quah C, Syme G, Swamy GN, Nanjayan S, Fowler A, Calthorpe D (2014) Obesity and recurrent intervertebral disc prolapse after lumbar microdiscectomy. Ann R Coll Surg Engl 96:140–143. https://doi.org/10.1308/003588414X13814021676873CrossRefPubMedPubMedCentral

40.

Rihn JA, Kurd M, Hilibrand AS, Lurie J, Zhao W, Albert T, Weinstein J (2013) The influence of obesity on the outcome of treatment of lumbar disc herniation: analysis of the spine patient outcomes research trial (SPORT). J Bone Joint Surg Am 95:1–8. https://doi.org/10.2106/JBJS.K.01558CrossRefPubMedPubMedCentral

41.

Rogers LA (1988) Experience with limited versus extensive disc removal in patients undergoing microsurgical operations for ruptured lumbar discs. Neurosurgery 22:82–85. https://doi.org/10.1227/00006123-198801010-00013CrossRefPubMed

42.

Shimia M, Babaei-Ghazani A, Sadat BE, Habibi B, Habibzadeh A (2013) Risk factors of recurrent lumbar disk herniation. Asian J Neurosurg 8:93–96. https://doi.org/10.4103/1793-5482.116384CrossRefPubMedPubMedCentral

43.

Shin BJ (2014) Risk factors for recurrent lumbar disc herniations. Asian Spine J 8:211–215. https://doi.org/10.4184/asj.2014.8.2.211CrossRefPubMedPubMedCentral

44.

Sorensen LT, Karlsmark T, Gottrup F (2003) Abstinence from smoking reduces incisional wound infection: a randomized controlled trial. Ann Surg 238:1–5. https://doi.org/10.1097/01.SLA.0000074980.39700.31CrossRefPubMedPubMedCentral

45.

Spengler DM (1982) Lumbar discectomy. Results with limited disc excision and selective foraminotomy. Spine (Phila Pa 1976) 7:604–607CrossRef

46.

Stromqvist B, Fritzell P, Hagg O, Jonsson B, Sanden B, Swedish Society of Spinal S (2013) Swespine: the Swedish spine register: the 2012 report. Eur Spine J 22:953–974. https://doi.org/10.1007/s00586-013-2758-9CrossRefPubMedPubMedCentral

47.

Suk KS, Lee HM, Moon SH, Kim NH (2001) Recurrent lumbar disc herniation: results of operative management. Spine (Phila Pa 1976) 26:672–676. https://doi.org/10.1097/00007632-200103150-00024CrossRef

48.

Swartz KR, Trost GR (2003) Recurrent lumbar disc herniation. Neurosurg Focus 15:E10. https://doi.org/10.3171/foc.2003.15.3.10CrossRefPubMed

49.

Thome C, Barth M, Scharf J, Schmiedek P (2005) Outcome after lumbar sequestrectomy compared with microdiscectomy: a prospective randomized study. J Neurosurg Spine 2:271–278. https://doi.org/10.3171/spi.2005.2.3.0271CrossRefPubMed

50.

Thome C, Klassen PD, Bouma GJ, Kursumovic A, Fandino J, Barth M, Arts M, van den Brink W, Bostelmann R, Hegewald A, Heidecke V, Vajkoczy P, Frohlich S, Wolfs J, Assaker R, Van de Kelft E, Kohler HP, Jadik S, Eustacchio S, Hes R, Martens F, Annular Closure RCTSG (2018) Annular closure in lumbar microdiscectomy for prevention of reherniation: a randomized clinical trial. Spine J 18:2278–2287. https://doi.org/10.1016/j.spinee.2018.05.003CrossRefPubMed

51.

Watters WC 3rd, Bono CM, Gilbert TJ, Kreiner DS, Mazanec DJ, Shaffer WO, Baisden J, Easa JE, Fernand R, Ghiselli G, Heggeness MH, Mendel RC, O'Neill C, Reitman CA, Resnick DK, Summers JT, Timmons RB, Toton JF, North American Spine S (2009) An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spondylolisthesis. Spine J 9:609–614. https://doi.org/10.1016/j.spinee.2009.03.016CrossRefPubMed

52.

Watters WC 3rd, McGirt MJ (2009) An evidence-based review of the literature on the consequences of conservative versus aggressive discectomy for the treatment of primary disc herniation with radiculopathy. Spine J 9:240–257. https://doi.org/10.1016/j.spinee.2008.08.005CrossRefPubMed

53.

Weber H (1983) Lumbar disc herniation. A controlled, prospective study with ten years of observation. Spine (Phila Pa 1976) 8:131–140CrossRef

54.

Weinstein JN, Lurie JD, Tosteson TD, Tosteson AN, Blood EA, Abdu WA, Herkowitz H, Hilibrand A, Albert T, Fischgrund J (2008) Surgical versus nonoperative treatment for lumbar disc herniation: four-year results for the spine patient outcomes research trial (SPORT). Spine (Phila Pa 1976) 33:2789–2800. https://doi.org/10.1097/BRS.0b013e31818ed8f4CrossRef

55.

Wera GD, Dean CL, Ahn UM, Marcus RE, Cassinelli EH, Bohlman HH, Ahn NU (2008) Reherniation and failure after lumbar discectomy: a comparison of fragment excision alone versus subtotal discectomy. J Spinal Disord Tech 21:316–319. https://doi.org/10.1097/BSD.0b013e31813e0314CrossRefPubMed

56.

Wilke HJ, Ressel L, Heuer F, Graf N, Rath S (2013) Can prevention of a reherniation be investigated? Establishment of a herniation model and experiments with an anular closure device. Spine (Phila Pa 1976) 38:E587–E593. https://doi.org/10.1097/BRS.0b013e31828ca4bcCrossRef

57.

Yoo MW, Hyun SJ, Kim KJ, Jahng TA, Kim HJ (2014) Does obesity make an influence on surgical outcomes following lumbar microdiscectomy? Korean J Spine 11:68–73. https://doi.org/10.14245/kjs.2014.11.2.68CrossRefPubMedPubMedCentral

Title: Risk factors for early reherniation after lumbar discectomy with or without annular closure: results of a multicenter randomized controlled study
Authors: Jenny C. Kienzler
Javier Fandino
Erik Van de Kelft
Sandro Eustacchio
Gerrit Joan Bouma
The Barricaid® Annular Closure RCT Study Group
Publication date: 01-01-2021
Publisher: Springer Vienna
Keyword: Disc Herniation
Published in: Acta Neurochirurgica / Issue 1/2021
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-020-04505-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Risk factors for early reherniation after lumbar discectomy with or without annular closure: results of a multicenter randomized controlled study

Abstract

Background

Methods

Results

Conclusion

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Trial registration

Please log in to get access to this content

Other articles of this Issue 1/2021

How I do it? Extraforaminal lumbar interbody fusion assisted with biportal endoscopic technique

Outcomes from treatment of asymptomatic skull base meningioma with stereotactic radiosurgery

Neuromodulation of the subthalamic nucleus in Parkinson’s disease: the effect of fiber tract stimulation on tremor control

Bilateral double beta peaks in a PD patient with STN electrodes

Globus pallidus internus activity during simultaneous bilateral microelectrode recordings in status dystonicus

Long-term apparent diffusion coefficient value changes in patients undergoing radiosurgical treatment of meningiomas