Utility of the Annular Closure Device in the Treatment of Degenerative Disc Disease: A Meta-Analysis with Trial Sequential Analysis

Lumbar degenerative disc disease is a common etiology of lower backache and resulting morbidity, severe disease can even result in neurological deficits. Recurrence occurs even after surgical treatment and results in poor prognosis, loss of productivity, and increased healthcare costs. Novel methods to tackle this based on countering plausible biomechanical reasons for recurrence have emerged including the recently investigated Annular Closure Device (ACD). Few RCTs and numerous comparative studies and post-hoc analyses have evaluated its safety, efficacy, and health economics; this review aims to provide an objective overview of the ACD. It was observed that ACD use was associated with significantly lower reoperations and re-herniations while having comparable or slightly higher complication rates and significantly saving direct and indirect costs. Leg pain and Back pain at follow-up were comparable between ACD and control groups. TSA objectively reveals the need for more data to ascertain ACD safety and efficacy. ACD usage has been shown to reduce re-herniations, reoperations while having comparable back pain and complication rates; thus having a positive health economics benefit. This should encourage more widespread adoption of ACD which would function to reduce the data gap.