Large post-discectomy defects in the annulus fibrosis have previously been associated with an increased risk of recurrent disc herniation. Despite this, limited attention has been paid to the intraoperative recognition, size, and management of annular defects during routine lumbar discectomy. This observational, multicenter study reviewed surgical treatment variations and intraoperative findings related to annular defects in patients undergoing primary single-level lumbar discectomy at selected centers in the Netherlands and Australia between July 2018 and May 2020. Intraoperative data were collected using a standardized surgical report form. Analyses were descriptive, with exploratory subgroup analyses performed to provide additional context. A total of 179 cases were included (Netherlands n = 85; Australia n = 94). Mean patient age was 45.6 years, and 52% were female. Discectomies were most commonly performed at L4–5 and L5–S1 (91%). Annular defects were identified or created in 94% of cases. Among cases with complete defect measurements ( n = 151), large annular defects (≥ 6 mm) were present in 110 cases (72.8%). Defects were frequently not apparent at initial exposure and were identified only after surgical exploration in nearly half of cases. Considerable variability was observed in surgical technique and adjunctive intraoperative management. Annular defects are highly prevalent in patients undergoing lumbar discectomy and are frequently larger than commonly perceived. Despite discectomy being regarded as a standardized procedure, substantial variability exists in defect recognition and management. These findings highlight annular defect morphology as an under-recognized intraoperative feature and provide descriptive insight into real-world surgical practice. Further outcome-focused research is needed to clarify the clinical implications of annular defect characteristics.
Arts et al. (Tue,) studied this question.