Guidelines: Annular Closure Prosthesis

  • Skeletally mature patients with posterior or posterolateral disc herniations (primary or recurrent) between L1 and S1 with radiographic confirmation of neural compression on MRI.
  • Unilateral radiculopathy (with or without back pain) with a positive Straight Leg Raise (0-60 degrees) (L4/5, L5/S1) or Femoral Stretch Test (L1/2, L2/3, L3/4).
  • In case of no neurological deficit, at least 6 weeks of failed conservative treatment prior to surgery
  • In case of neurological deficit, surgery may be considered earlier than 6 weeks.
  • Minimum posterior disc height of 5mm at the index level.
  • Intra-operative confirmation of an anular defect that is at least 4mm – 6mm in height and 5mm – 12mm in width.


  • Spondylolisthesis and/or instability
  • Intra-operative measurement of defect that is too wide (>12mm) or too tall (>6mm)
  • Intra-operative measurement of defect that is too small (<4mm in height and <5mm in width)
  • Posterior disc height <3mm
  • Subject has clinically compromised vertebral bodies in the lumbosacral region due to any traumatic, neoplastic, metabolic, or infectious pathology.
  • Osteoporosis.
  • Extra-foraminal disc herniations.
  • Central Spinal Canal stenosis.

This protocol was discussed and approved at the SA Spine Society executive committee meeting held on May 28, 2014 in Cape Town

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