Prevalence of Symptomatic Reherniation After Lumbar Discectomy Using a Bone-Anchored Annular Closure Device and Associated Contributing Factors: A Meta-Analysis.

Introduction: The primary issue following lumbar discectomy for disc herniation is the risk of reherniation in the post-operative period. Many surgical techniques have been proposed to treat disc reherniation, however, the optimal one remains variable. This meta-analysis aimed to investigate the prevalence of symptomatic reherniation after using a Bone-anchored annular closure device following lumbar discectomy and the contributing factors. Materials and methods: Identification of published literature was performed on PubMed, Google Scholar, Scopus, and Web of Science databases. Studies published until 14 February 2024 reported the prevalence of symptomatic reherniation after using a Bone-anchored annular closure device following lumbar discectomy and the associated contributing factors. A random effects model was used to conduct Bayesian frequentist network meta-analysis and pair-wise meta-analysis, with the assessment based on standardised mean difference (SMD) and 95% confidence interval (CI). Results: Eleven studies published in 2012 - 2022 recruiting a total of 5195 patients were included in the meta-analysis. The prevalence of reherniation in ACD and control groups was 23.2% (95% CI: 18.2% - 28.1%) and 36.4% (95% CI: 28.2% - 44.5%), respectively. The moderator effect of sample size is significant for pooled data of the ACD group (p-mod=0.002), but not for the control group (p-mod=0.278). After the adjustment with sample size, the prevalence rates were 13.6% (95% CI: 6.2% - 21.1%) and 29.6% (95% CI: 14.9% - 33.2%) for ACD and control groups, respectively. Conclusion: Comparatively to lumbar discectomy alone, using a Bone-anchored annular closure device following lumbar discectomy decreased the symptomatic reherniation rate and post-operative complications, as well as the necessity for subsequent surgeries.