Annular repair method in lumbar disc herniation: A systematic review and network meta-analysis
Journal
Asian Journal of Surgery
ISSN
1015-9584
Date Issued
2026-02
Author(s)
Abstract
Lumbar discectomy is a surgical procedure for treating lumbar disc herniation. While it is effective at alleviating symptoms, it fails to address the structural issues of the intervertebral disc. This study aimed to investigate the efficacy of annular repair in reducing recurrence rates and improving clinical outcomes, including pain, the Oswestry Disability Index, and endplate changes. A protocol was registered in PROSPERO (CRD42024582943). The study adhered to the PRISMA guidelines, and a systematic search was conducted in the PubMed, Scopus, and Embase databases for articles published between 2000 and September 2024. Eighteen studies encompassing 2468 patients were included. Study selection, data extraction, and quality assessment were independently performed by three reviewers. The results revealed that annular repair significantly reduced the risk of reherniation (OR = 0.36; 95% CI: 0.22–0.57; I2 = 14%) and reoperation (OR = 0.42; 95% CI: 0.27–0.65; I2 = 0%). In contrast, no significant improvements were found in back pain (SMD = −0.17, 95% CI: −0.41, 0.07; I2 = 59%), leg pain (SMD = −0.26, 95% CI: −0.61, 0.10; I2 = 73%), or the Oswestry Disability Index (MD = −1.52, 95% CI: −3.97, 0.94; I2 = 69%). Network meta-analysis indicated that ACD had the highest probability of being the most effective intervention for preventing reherniation, while both ACD and biomaterials (BM) achieved the highest cumulative ranking probabilities for reducing reoperation risk. These findings suggest that annular repair may help reduce reherniation and reoperation following lumbar discectomy, although improvement in patient-reported outcomes is limited. © 2026 Asian Surgical Association and Taiwan Society of Coloproctology. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license. http://creativecommons.org/licenses/by-nc-nd/4.0/
Subjects
Annular repair
Discectomy
Intervertebral disc herniation
Meta-analysis
Network meta-analysis
Publisher
Elsevier BV
Type
review article