Annuloplasty as a method to prevent recurrent herniation of lumbar intervertebral discs

Among patients with herniation of the intervertebral disc (HIVD), surgical treatment is recommended for patients with failure of conservative treatment or severe muscle weakness [1,2]. During surgical treatment, the herniated disc is removed to relieve the compressed cauda equina or nerve roots. Although surgical treatment is performed successfully, the risk of recurrence is reported to be up to 15% [3–5]. Objective: Recurrent disc herniation occurs frequently after discectomy and is associated with annulus fibrosus defects. This study evaluated the effectiveness of annuloplasty in preventing recurrent intervertebral disc herniation following microscopic discectomy. Methods: We analyzed 102 patients (56 males, 46 females) who underwent discectomy between December 2019 and February 2021. Twenty-two patients received annuloplasty using sutures and 80 did not. Surgical and clinical outcomes and the herniation recurrence rate were compared between the groups. Results: The mean age was significantly lower in the suture group than in the non-suture group (54.55±10.12 years vs. 60.60±12.20 years; P=0.021). There were no significant between-group differences in sex, body mass index, or length of follow-up. The surgical outcomes, such as operation time (66.82±13.01 minutes vs. 63.14±20.54 minutes; P=0.305) and estimated blood loss (54.55±14.71 mL vs. 59.77±19.59 mL; P=0.175), did not differ significantly between the groups. No significant between-group difference was found in the proportion of patients with lower extremity weakness preoperatively (63.6% vs. 48.8%; P=0.155), and at 1 (36.4% vs. 25.0%; P=0.275) and 6 months (13.6% vs. 11.3%; P=0.707) postoperatively. There were no cases of recurrent herniation in the suture group, whereas the recurrence rate was 5.0% in the non-suture group. Conclusion: Despite the non-statistically significant results, annuloplasty may serve as a simple method to prevent recurrent intervertebral disc herniation.