barricaid_annular_closing_device_case_reports

Lange et al., from the Department of Neurosurgery, Klinikum Rechts der Isar, Technische Universität Munich, Germany, report the unusual case of a young patient with reoperation after annuloplasty using the Barricaid® (Intrinsic Therapeutics, Woburn, MA, USA) closure device.

A 32-year-old man underwent lumbar discectomy and annuloplasty of the level L5-S1. Five years later, the patient presented with a new onset of low back pain radiating into the right leg. Imaging revealed loosening of the annulus repair device. The device was removed surgically and the patient was pain free thereafter. Annular closure devices such as the Barricaid system aim to improve outcome after lumbar discectomy by reducing the risk of recurrent disc herniation of the same level. Data on long-term follow-up are missing. This is the first case of symptomatic device loosening 1).


Krutko et al.,described a case of reoperation after microdiscectomy and annuloplasty using the Barricaid®.

A month after the operation, the patient complained of back and right leg pain. Examination revealed bone resorption around the implant and signs of inflammatory changes in the adjacent tissues. Laboratory analysis revealed no increase in acute-phase response indicators. Taking into account the clinical data, the data obtained by instrumental methods, and resistance to conservative therapy, the patient underwent revision surgery. No signs of purulent inflammation around the implant were revealed intraoperatively. The implant resided at a typical site but was easy to displace. The adjacent tissue was harvested for bacteriological examination. The revealed changes were regarded as aseptic loosening of the implant. A decision was made to remove the implant and perform transpedicular and interbody fixation of the functional spinal unit. The bacteriological study of peri-implant tissues revealed no microflora growth. The patient was mobilized on the day of surgery. The wounds healed by primary intention. On day 7, the patient was discharged for outpatient treatment. At discharge, the VAS scores of leg pain and back pain were 0 and 4, respectively. Patient’s condition remained stable within the subsequent 9 months: he had no complaints and experienced no pain 2).


1)
Lange N, Meyer B, Shiban E. Symptomatic annulus-repair-device loosening due to a low-grade infection. Acta Neurochir (Wien). 2018 Jan;160(1):199-203. doi: 10.1007/s00701-017-3371-1. Epub 2017 Oct 26. PubMed PMID: 29075906.
2)
Krutko AV, Baykov ES, Sadovoy MA. Reoperation after microdiscectomy of lumbar herniation: Case report. Int J Surg Case Rep. 2016;24:119-23. doi: 10.1016/j.ijscr.2016.04.043. Epub 2016 May 12. PubMed PMID: 27236580; PubMed Central PMCID: PMC4887591.
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