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The effectiveness and safety of annulus closure device implantation in lumbar discectomy for patients with lumbar disc herniation: a systematic review and meta-analysis

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Abstract

Objective

The objective of this study was to systematically estimate the effectiveness and safety of annulus closure device (ACD) implantation in discectomy for patients with lumbar disc herniation (LDH).

Methods

A systematic search was performed on PubMed, EMBASE and the Cochrane Library for randomized controlled trial (RCT) from inception until April 16, 2022. Trials which investigated comparisons between with and without ACD implantation in discectomy for LDH patients were identified.

Results

In total, five RCTs involving 2380 patients with LDH underwent discectomy were included. The included patients were divided into ACD group and control group (CTL). Significant differences were found in the rate of re-herniation (ACD: 7.40%, CTL: 17.58%), reoperation (ACD: 5.39%, CTL: 13.58%) and serious adverse event (ACD: 10.79%, CTL: 17.14%) between ACD group and CTL group. No significant difference was found in VAS-BACK, VAS-LEG, ODI and SF-12 PCS between ACD and CTL. The surgical time of ACD was longer than CTL with statistical significance. In subgroup analyses based on discectomy type, significant differences were found in the rate of re-herniation (ACD: 10.73%, CTL: 21.27%), reoperation (ACD: 4.96%, CTL: 13.82%) and serious adverse event (ACD: 7.59%, CTL: 16.89%) between ACD and CTL in limited lumbar discectomy (LLD).

Conclusion

Discectomy either with or without ACD implantation is considered to achieve similar clinical outcomes. Whereas, the ACD implantation in LLD is associated with lower re-herniation and reoperation rate but prolonged surgical time for LDH patients. Researches on cost-effectiveness and effect of ACD implantation in different discectomy are needed in the future.

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Abbreviations

ACD:

Annulus closure device

LDH:

Lumbar disc herniation

LLD:

Limited lumbar discectomy

SCIE:

Science citation index expanded

WoS:

Web of Science

PRISMA:

Preferred reporting items for systematic reviews and meta-analyses

RCT:

Randomized controlled trial

MED:

Micro-endoscopic discectomy

PED:

Percutaneous endoscopic discectomy

UBE:

Unilateral biportal endoscopic discectomy

VAS:

Visual analogue scale

SEA:

Serious adverse event

ODI:

Oswestry disability index

SF-12 PCS:

Physical component summary of 12-item short-form health survey

MD:

Mean difference

95% CI:

95% Confidence interval

OR:

Odds ratio

ALD:

Aggressive lumbar discectomy

VEPC:

Vertebral endplate changes

NA:

Not available

Exp:

Experimental group

CTL:

Control group

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Acknowledgements

This study was supported by National Natural Science Foundation of China (NO: 81871803). The funder had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Author notes

  1. Wei-Shang Li and Gao-Yu Li have contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopedic Surgery, The First Hospital of China Medical University, No.155, Nanjing Bei Street, Shenyang, 110001, People’s Republic of China

    Wei-Shang Li & Lin Cong

  2. Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, No.36, Sanhao Street, Shenyang, 110001, People’s Republic of China

    Gao-Yu Li

  3. Departments of Surgery, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7741, San Antonio, TX, 78229-3900, USA

    Qi Yan

  4. Disease Control and Prevention Center of China Railway Shenyang Bureau Group Corporation, No.4, Taiyuan Bei Street, Shenyang, 110001, People’s Republic of China

    Wen-Ting Chen

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Li, WS., Li, GY., Yan, Q. et al. The effectiveness and safety of annulus closure device implantation in lumbar discectomy for patients with lumbar disc herniation: a systematic review and meta-analysis. Eur Spine J 32, 2377–2386 (2023). https://doi.org/10.1007/s00586-023-07629-0

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