The Ideal Patient for Barricaid®

The effect of anular defect size on patient selection

The Barricaid® is intended to be used as an adjunct to a lumbar limited discectomy to replace missing or damaged section of the anulus identified at the time of surgery. For detailed information on specific indications and contra indications, please refer to the approved Instructions For Use.

• In cases of limited discectomy, patients with larger defects are more likely to reherniate – patients with small or ‘slit’ defects have a very low risk.  ¹Carragee, E, et al: Clinical Outcomes After Lumbar Discectomy for Sciatica: The Effects of Fragment Type and Anular Competence. JBJS 2003: 85-A (1): 102-108.

• Patients with larger defects have a reherniation risk as high as 27% - patients with small defects have a risk of reherniation as low as 1%. ¹Carragee, E, et al: Clinical Outcomes After Lumbar Discectomy for Sciatica: The Effects of Fragment Type and Anular Competence. JBJS 2003: 85-A (1): 102-108.,² McGirt MJ, et al: A prospective cohort study of close interval computed tomography and magnetic resonance imaging after primary lumbar discectomy: factors associated with recurrent disc herniation and disc height loss. Spine 2009;34:2044-2051.

The importance of disc height in patient selection

• Patients with taller discs and more nucleus are more likely to benefit from the Barricaid®’s improved disc height maintenance (compared to the control).
• Taller discs are likely to exhibit improved ranges of motion ²McGirt MJ, et al: A prospective cohort study of close interval computed tomography and magnetic resonance imaging after primary lumbar discectomy: factors associated with recurrent disc herniation and disc height loss. Spine 2009;34:2044-2051. and less low back pain ³Yorimitsu E, et al: Long-Term Outcomes of Standard Discectomy for Lumbar Disc Herniation. Spine 2001;26(6):652-657. over collapsed discs.

Ideal patient selection summary

• More active ⁴Moliterno, et al: Results and risk factors for recurrence following single-level tubular lumbar microdiscectomy. J Neurosurg Spine 2010;12:680-686
  ,⁵Ljungberg et al: Occupational Lifting by Nursing Aides and Warehouse Workers. Ergonomics 1989;32(1):59-78.
• Good pre-operative disc height: 5+mm
• Larger anular defect: ≥5mm

Two-step patient screening

• Pre-operatively, disc height measures equal or > 5mm
• Pre-operatively, exclude patients with:
  • Collapsed discs, osteoporosis, spinal tumors, or other obvious contra- indications
  • Less than 3mm posterior bony disc height
• Intra-operatively: anular defect size measures between 3-6mm in height & 5-12mm  in width