An educational update for all persons in the care of injured worker’s compensation patients within the State of Florida. This is a free education update provided by Anulex Technologies, Inc.
Featured Surgeon: Phillip G. St. Louis, M.D., F.A.C.S.
Microdiscectomy and Anular Repair
Lumbar microdiscectomy is the most common surgical procedure performed in the spine with over 750,000 microdiscectomies performed worldwide each year. Although a relatively straight forward procedure, complications can arise after surgery, such as continued pain, further disc degeneration, or re-herniations.
Educate Yourself: What does a Herniated Disc look like on MRI?
*Notice the herniated disc rupture putting pressure on the nerve root in the left side image. Then notice the same area free after the ruptured disc was removed during the discectomy and anular repair.
What can help prevent Re-herniations (additional surgeries)?
It has long been accepted by most surgeons that there is a 10-15% re-herniation rate after a discectomy procedure. Several studies indicate the number could be as high as 25%, depending upon the surgeon. This occurs when a slit is created in the anulus to relieve the herniated portion of the disc in the initial operation. That initial hole (anulotomy) in the disc is not repaired or closed. Patients then resume normal activities with no tissue offering resistance to more nucleus of the disc rupturing out of the anulotomy. This often results in a re-herniation. However, in a two-year follow-up study with 254 patients, Anular Repair was shown to help reduce the re-herniation rate by up to 68%.1
What Costs are Associated with Re-herniations?
In a recent study conducted by surgeons at Johns Hopkins Hospital (Neurosurgery 65:574–578, 2009), the average cost of treatments for patients who required re-operations for recurrent herniations at one year follow up was $39,836.
So, what can physicians do to ensure patients that undergo surgery for a herniated disc don’t have the greater possibility of re-herniation and additional medical costs associated with a re-do surgery?
Consider anular repair at the end of the discectomy procedure. The initial cost of an anular repair is a fraction of the cost of a re-herniation and can be performed during the first discectomy procedure. Potential better outcomes and more cost effective surgery – adjuster and case managers should require it.
Over 25 surgeons in Florida have utilized the Xclose™ Tissue Repair System (Anulex Technologies, Inc.) to perform the anular repair procedure. Reduced re-herniation rates help to drive down the overall cost of workers’ compensation insurance.
Dr. St. Louis has been utilizing anular repair and has seen the positive results with his patients. If you have a patient that has pain and is a possible surgical candidate for a discectomy procedure, refer the patient a surgeon who utilizes anular repair. Think Anular Repair!
For more information go to www.anulex.com, or contact Dr. Phillip St. Louis (contact information below)
Who is Dr. St. Louis?
Dr. St Louis is a Fellow of the American College of Surgeons and is certified in Neurological Surgery by the American Board of Neurological Surgeons. He has been active in the practice of Neurosurgery (Spine and Brain Surgery) in Orlando since 1983 and retains active privileges at Orlando Regional Medical Center and Florida Hospital Orlando, where he currently serves as the Director of the Neuro Critical Care Unit.
Dr. St. Louis completed his internship and neurological surgery residency at the Cleveland Clinic Foundation. During his training, he received the William E. Lower Fellowship prize for the most outstanding thesis presented on a clinical subject. He obtained special training in pediatric neurosurgery as a fellow at the Hospital for Sick Children in Toronto, Canada. He received his medical degree from Hahnemann Medical College in Philadelphia.
For more information about Dr. St. Louis’ accomplishments, please visit his website at: www.ain.md
Phillip G. St. Louis, M.D., F.A.C.S.
Associates in Neurosurgery
532 Virginia Drive
Orlando, FL 32803
Office: (407) 898-8644
Fax: (407) 898-8646
John Orlando, Anular Repair Specialist – PH (813) 766-2656 – email@example.com
1Cauthen JC. Chapter 11. Microsurgical Anular Reconstruction (Anuloplasty) Following Lumbar Microdiscectomy: 155-177. In: Spinal Arthroplasty; A New Era in Spine Care, Guyer RD, editor. St. Louis, Missouri; Quality medical Publishing, 2005