Study: Annular Closure Device Good Option

A multicenter study from Northwestern University, the University of California-Davis, and the OLVG Hospital in Amsterdam, has looked into the costs associated with employing an annular closure device for patients who are at high risk for recurrent herniation after a discectomy.

Their work, “Cost-effectiveness of a Bone-anchored Annular Closure Device VersusConventional Lumbar Discectomy in Treating Lumbar Disc Herniations,” appears in the January 1, 2019 edition of Spine.

Co-author Wellington K. Hsu, M.D., the Clifford C. Raisbeck Distinguished Professor of Orthopaedic Surgery and director of Research at the Northwestern University Feinberg School of Medicine in Chicago, described the rationale and objective of his study to OTW, “Recurrent lumbar disc herniations are among the most common complications after a microdiscectomy, which is the most common spine procedure that most spine surgeons perform. They are more common in the younger patient population and can wreak havoc on one’s life.”

“These complications often lead to additional surgery, which increases further complication and decrease quality of life. Any way that I can decrease the incidence of this complication after this routine procedure is welcome in my clinical practice.”

Dr. Hsu’s study was a cost-utility analysis where the researchers “calculated direct costs based on Humana and Medicare 2014 claims to represent private and public payer data, respectively. Indirect costs were calculated for lost work days using 2016 U.S. average annual wages. The incremental cost-effectiveness ratio (ICER) in dollars per quality-adjusted life year (QALY) was compared to willingness-to-pay thresholds.”

Dr. Hsu told OTW, “In my opinion, the most important results involve the fact that in a well-controlled, well-powered, randomized study that identifies high risk patients for this complication, the use of this novel Barricaid device decreases the complication of a recurrent disc herniation.”

“While many other similar studies in the literature that do not have as many patients or are not as well-controlled do not show the same results testing other devices, I am convinced with this data that this type of product has a benefit in the younger patient population who needs lumbar microdiscectomy.”

“I believe that all spine surgeons must recognize that a recurrent lumbar disc herniation is a relatively common and potentially debilitating condition. Since being in clinical practice, I have not seen any clinical study that has convinced me to utilize any adjunctive devices during primary lumbar microdiscectomy. This study demonstrates that there is value in utilizing this technology in certain patients who are at high risk for this complication.”

“I believe that orthopedic surgeons should know that a carefully designed annular closure device can have significant benefit in patients who are at high risk for a recurrent lumbar disc herniation.”