Effect of a strutted intradiscal spacer (DIVA®) on disc reherniation following lumbar discectomy: A 2-year retrospective matched cohort study

Abstract

Introduction: Discectomy for lumbar disc herniation has a high rate of reoperation and recurrent herniation.

Methods: Retrospectively matched cohort of patients undergoing lumbar discectomy alone or with a strutted intradiscal spacer.

Results: 133 discectomy and 112 patients with discectomy plus spacer were included. Pain and disability scores were significantly lower for both groups at 2 years. Patients receiving a strutted intradiscal spacer following discectomy had a reduced rate of all-cause reoperations and operations for recurrent herniations compared to discectomy alone.

Conclusion: Use of a strutted intradiscal spacer following discectomy improves surgical outcomes following surgery for lumbar herniation versus discectomy alone.

Keywords: ALIF, Anterior Lumbar Interbody Fusion; ASD, Absolute Standardized Difference; DIVA; DIVA, Device for Intervertebral Autonomy; Disc herniation; Intradiscal spacer; Lumbar discectomy; ODI, Oswestry Disability Index; PLIF, Posterior Lumbar Interbody Fusion; Reherniation; VAS, Visual Analogue Scale.

Fig. 1

A) Anterior-posterior and (B) lateral x-rays of the lumbar spine showing proper placement of the strutted intradiscal spacer.

Fig. 2

Kaplan-Meier curve for cumulative risk of reoperation over 2-year post-procedure period.

Fig. 3

Cox-proportional hazard ratio for reoperation for treatment group vs. control group patient characteristics. VAS = Visual Analogue Scale, ODI = Oswestry Disability Index. Plotted values are hazard ratio and 95% confidence interval. Hazard ratio <1 indicates lower risk with treatment and >1 indicates higher risk with treatment. Continuous variables are categorized by the median value.

Fig. 4

Kaplan-Meier curve for cumulative risk of reoperation for reherniation over 2-year post-procedure period.