Minimal Discectomy vs. MIS Discectomy

Surgical spinal procedures have moved towards minimally invasive surgery (MIS) techniques. Despite this, improvements in microdiscectomy procedures have focused mainly on minimizing the opening for surgical access. Limited improvements have been made since discectomies have been established as a standard of care.

The next step for minimally invasive discectomy procedures extends beyond surgical access and allows for native tissue conservation.

The AnchorKnot® Tissue Approximation Kit can be used in herniated disc repair procedures by surgeons interested in disc preservation as part of a tissue sparing approach including securing residual defects. Studies have shown that smaller defects result in better procedural outcomes. 5

The minimal discectomy technique involves reducing the trauma to the disc by minimizing the annular incision (if an incision is required), and limiting the removal of tissue to include only the free fragments impinging on the nerve root. Finally, before completion of the procedure, the defect may be secured.

Current discectomy challenges

Although discectomies are one of the most commonly performed surgical spinal procedures, the dilemma between aggressive vs. minimal discectomy techniques has been discussed for as long as the procedure has been established.

Removing more disc material has been shown to reduce the risk of herniation, but it has also been shown to promote disc degeneration by 26%, 2 years post-surgery 6. Conversely, the removal of less disc material may be beneficial to prevent unnecessary disc degeneration but this has been associated with increased risk of reherniation 7.

Until now, there has been no consensus on the amount of disc material to remove during the discectomy procedure. The AnchorKnot® Tissue Approximation Kit in herniated disc repair procedures is a commercially available system to enable minimal discectomy with disc preservation in mind.

Aggressive Discectomy (AD)

Reduces reherniation, decreases native disc preservation (26% disc collapse in 2 years), worse long-term patient outcome.18

Poor Disc Preservation

Low Herniation Risk

Minimal Discectomy

Increases reherniation (2x more than aggressive), increases native disc preservation, better long term patient outcome (2.5x less reported incidents of recurrent back or leg pain compared to AD).8

Good Disc Preservation

High Reherniation Risk

Minimal Discectomy with Disc Preservation

Enables techniques of native disc preservation and secures the benefits from a minimal discectomy.

Optimal Disk Preservation

Low Reherniation Risk

Strength testing

The strength of the knot delivered by The AnchorKnot® Tissue Approximation Kit was evaluated using flexion and extension tests for 85,000 cycles while loaded at 1,500N, illustrating the strength of the secured knot 9.

The strength loads used for the testing are similar to those encountered in daily activities and mimic biomechanical motion.

INDICATIONS FOR USE
In the United States: The AnchorKnot Suture Passer (2-0), AnchorKnot Knot Pusher (2-0) and AnchorKnot Suture Cutter (2-0) are accessories of the Anchor System. The indications are: The Anchor System is indicated for visualization of the surgical field in any area of the body cut open during a surgical procedure. When used in the cervical, thoracic, or lumbar spine either from an anterior or posterior direction, for example, the Anchor Endoscope and accessories are intended to aid the surgeon’s visualization of the surgical area and allow him/her to perform any type of surgical spinal procedure such as herniated disc repair, visualization of the circumferential decompression of the nerve roots, aiding in the search and removal of nucleus material, spinal fusion, or insertion of spinal implants. Other examples of generic surgical use of the Anchor System would be for use in the knee, ankle, shoulder, hand, wrist, and temporomandibular joint (TMJ).
In Canada: The AnchorKnot Knot Pusher (2-0) and AnchorKnot Suture Cutter (2-0) are intended for use during surgical spinal procedures, such as herniated disc repair. The AnchorKnot Suture Passer (2-0) is indicated for passing suture through tissue during surgical spinal procedures, such as herniated disc repair.
CAUTION: Federal Law (USA) restricts the use of these devices to or by the order of a physician. Before use, consult product labels and inserts for any indications, contraindications, hazards, warnings, cautions and instructions for use.