ABSTRACT
The performance of a microdiscectomy procedure for the treatment of a lumbar disc herniation is a well-accepted surgical procedure with a proven track record. In spite of the perceived success rate for this procedure, there remains room to improve clinical outcomes, and ultimately reduce the risk of recurrent disc herniations, thereby reducing the rate of second operative procedures. Clinical research has shown excellent/good results-in some series to be less than 75%, and large population-based studies suggest that reoperation rates after discectomy can range from 9% to 20% within five years. Techniques for the careful repair of the annulus fibrosus after discectomy have included microsurgical suturing, sealants, and more recently, barrier implants. A minimally invasive technique for the repair of soft tissues, such as the annulus fibrosus, utilizing a barrier mesh implant of polyethylene terephthalate (PET) placed in proximity to the inner annular wall and nucleus pulposus has recently been developed. Biomechanics, animal experimentation (with histology), and early clinical experiences have shown this novel approach to be technically feasible. Successful annular repair, reconstruction, and reinforcement potentially can positively affect the ultimate surgical result by enabling a less aggressive discectomy, thus preserving spinal biomechanics; preventing future nucleus pulposus expulsion; or protecting the neural elements from inflammatory mediators that might be implicated in epidural fibrosis or pain.
