Abstract
Objective
The aim of the study is to evaluate whether discectomy combined with annulus fibrosus repair to treat lumbar disc herniations is effective and investigate the implications of each annulus fibrosus repair method for clinical practice.
Methods
PRISMAP guidelines were followed in this review. PubMed, Embase, Cochrane, Web of Science databases and the reference list grey literature were searched for randomized controlled trials (RCTs), screened the studies according to inclusion criteria, and extracted the data and analyzed by Review Manage (version 5.4).
Results
10 RCTs with 2197 patients were included in this study. The results showed that the risk of post-operative reherniations (RR: 0.42, 95%CI [0.30, 0.58], P < 0.00001) and the risk of reherniation-related reoperations (RR: 0.63, 95%CI [0.46, 0.87], P = 0.005) were markedly lower in the discectomy with annulus fibrsous repair (DAFR) group compared with discectomy alone (DA) group. The two groups had no significant difference in ODI, VAS-back pain, VAS-leg pain, and SF-scale. The DAFR group had a longer operative time and a higher postoperative disc height than the control group. It was obtained by the subgroup analysis that the Barricaid repair method was more effective in reducing the risk of reherniations and the risk of reherniation-related reoperations compared with other repair methods relatively.
Conclusion
Discectomy with annulus fibrosus repair reduced the risk of reherniations and the risks of reherniation-related reoperations but could not reduce postoperative pain and improve overall health status better than discectomy alone. Discectomy with annulus fibrosus repair had a better ability to maintain disc height but had a longer operative time.