GUIDELINES: ANNULAR CLOSURE PROSTHESIS
- Skeletally mature patients with posterior or posterolateral disc herniations (primary or recurrent) between L1 and S1 with radiographic confirmation of neural compression on MRI.
- Unilateral radiculopathy (with or without back pain) with a positive Straight Leg Raise (0-60 degrees) (L4/5, L5/S1) or Femoral Stretch Test (L1/2, L2/3, L3/4).
- In case of no neurological deficit, at least 6 weeks of failed conservative treatment prior to surgery
- In case of neurological deficit, surgery may be considered earlier than 6 weeks.
- Minimum posterior disc height of 5mm at the index level.
- Intra-operative confirmation of an anular defect that is at least 4mm – 6mm in height and 5mm – 12mm in width.
- Spondylolisthesis and/or instability
- Intra-operative measurement of defect that is too wide (>12mm) or too tall (>6mm)
- Intra-operative measurement of defect that is too small (<4mm in height and <5mm in width)
- Posterior disc height <3mm
- Subject has clinically compromised vertebral bodies in the lumbosacral region due to any traumatic, neoplastic, metabolic, or infectious pathology.
- Extra-foraminal disc herniations.
- Central Spinal Canal stenosis.
This protocol was discussed and approved at the SA Spine Society executive committee meeting held on May 28, 2014 in Cape Town