1510. Clinical Evaluation of Suture-Based Herniated Disc Repair Following Lumbar Microdiscectomy

Authors: George V. Huffmon III, MD, FAANS; George Huffmon, MD (Wilmington, NC)

Introduction: Lumbar microdiscectomy involves the resection of intervertebral disc material to alleviate nerve root pressure for patients suffering from radicular leg pain with or without motor or sensory deficit. Despite significant symptomatic pain relief, recurrent disc herniation is reported in up to 18% of patients, and is a source of persistent pain and repeat surgery. Herniated disc repair has been proposed as a means of reducing the rate of recurrent disc herniation. The purpose of this study was to report on the clinical feasibility of suture-based closure as a means of herniated disc repair. Methods: Patients undergoing microdiscectomy at a single centre, between 29-Jan-2018 and 05-Sep-2018, were considered for herniated disc repair. An intra-operative assessment of annular tissue quality and instrument access was made following index procedure. If the defect was deemed repairable, suture-based repair was attempted. The suture was comprised of non-absorbable ultra-high molecular weight polyethylene suture and was delivered using a single-use delivery device. Post-operative follow-up was completed at eight weeks to assess for reherniation symptoms and surgical complications. Results: Thirteen microdiscectomy patients were considered for suture-based herniated disc repair. Following intra-operative assessment, 9 of 13 patients (69%) had defects deemed amenable to repair. Suture based repair was attempted and achieved in all 9 patients. Herniated disc repair was not attempted if there was insufficient competency of the annulus fibrosus tissue or inaccessibility to defect margins. There were no signs of surgical complications, nerve root irritation, or reherniation during standard eight week follow-up time. Conclusion: Satisfactory herniated disc repair was achieved in all attempted patients. Annulus tissue competency and instrument access appear to be key elements of intra-operative patient selection. Further study is required to assess the broader applicability of herniated disc repair, and the potential impact on the rates of recurrent herniation and revision surgery.