A retrospective study of the mid-term efficacy of full-endoscopic annulus fibrosus suture following lumbar discectomy

Zhenfei Wang; Sen Huang; Long Xu; Jinhui Bu; Guangpu Liu; Hui Wang; Jun Liang; Mengjiao Xia; Tao Chen; Chao Ma; Kerong Dai; Guangwang Liu

doi:10.3389/fsurg.2022.1011746

A retrospective study of the mid-term efficacy of full-endoscopic annulus fibrosus suture following lumbar discectomy

Front Surg. 2022 Oct 25:9:1011746. doi: 10.3389/fsurg.2022.1011746. eCollection 2022.

Authors

Zhenfei Wang¹, Sen Huang², Long Xu³, Jinhui Bu², Guangpu Liu¹, Hui Wang¹, Jun Liang⁴, Mengjiao Xia¹, Tao Chen¹, Chao Ma¹, Kerong Dai⁵, Guangwang Liu¹

Affiliations

¹ Department of Orthopedic Surgery, XuZhou Central Hospital, XuZhou Clinical School of Xuzhou Medical University, XuZhou Central Hospital Affiliated to Nanjing University of Chinese Medicine, The Xuzhou School of Clinical Medicine of Nanjing Medical University, XuZhou Central Hospital Affiliated to Medical School of Southeast University, Xuzhou, China.
² XuZhou Clinical School of Xuzhou Medical University, Xuzhou, China.
³ Graduate School of Bengbu Medical College, Bengbu, China.
⁴ XuZhou Central Hospital, XuZhou, China.
⁵ Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.

Abstract

Aims: Full-endoscopic discectomy is associated with a high risk of disc reherniation due to the poor mechanical strength of the annulus fibrosus after scar healing. It is technically difficult to place a full-endoscopic annulus fibrosus suture. We designed an annulus fibrosus suture device that can be used to suture annulus defects under microendoscopy. The present study investigated the safety and feasibility of this technology.

Patients and methods: We retrospectively analyzed the outcomes of patients who underwent surgical treatment for lumbar disc herniation (LDH) from January 2018 to October 2020. We compared 40 patients with LDH treated with full-endoscopic annulus fibrosus suture following lumbar discectomy (LD + AFS group) with 42 patients treated with lumbar discectomy alone (LD group) regarding demographic data, symptoms, and recurrence and reoperation rates. Lumbar MRI and CT were performed 3 and 12 months. A 10-point visual analog scale (VAS) and the Oswestry Disability Index (ODI) was used to evaluate pain and the lumbar spine function.

Results: The cohort comprised 82 patients, including 40 patients in the LD + AFS group and 42 in the LD group. All operations were successfully completed without serious complications. Reherniation occurred in no patients in the LD + AFS group and three patients in the LD group. The VAS scores for lumbar and leg pain and ODI score were significantly improved postoperatively (p < 0.05).

Conclusion: Compared with conventional lumbar discectomy, full-endoscopic annulus fibrosus suture following full-endoscopic lumbar discectomy is a safe and effective minimally invasive technique that reduces the LDH recurrence rate.

Keywords: annulus fibrosus suture; full-endoscopic discectomy; lumbar disc herniation; lumbar discectomy; minimally invasive spinal surgery.