PT  - JOURNAL ARTICLE
AU  - Lorio, Morgan P.
AU  - Kube, Richard A.
AU  - Ratliff, John
AU  - DiGiorgio, Anthony
AU  - Essig, David A.
AU  - Radcliff, Kris
AU  - Lewandrowski, Kai-Uwe
AU  - Block, Jon E.
TI  - ISASS Recommendations and Coverage Criteria for Bone-Anchored Annular Defect Closure Following Lumbar Discectomy: Coverage Indications, Limitations, and/or Medical Necessity—An ISASS 2025 Policy Update on the Use of Bone-Anchored Annular Closure to Prevent Reherniation in High-Risk Lumbar Discectomy Patients
AID  - 10.14444/8770
DP  - 2025 Jun 18
TA  - International Journal of Spine Surgery
PG  - 8770
4099  - https://www.ijssurgery.com/content/early/2025/06/17/8770.short
4100  - https://www.ijssurgery.com/content/early/2025/06/17/8770.full
AB  - Patients with symptomatic lumbar disc herniation with radiculopathy where there is a large residual annular defect following discectomy are at greater risk of reherniation with symptom recurrence and revision surgery. These patients may benefit from primary annular repair. In 2019, the International Society for the Advancement of Spine Surgery published clinical guidelines supporting the use of bone-anchored annular closure in patients with large annular defects who are at greater risk for recurrent disc herniation. This 2025 update is provided to (1) summarize the current, increased clinical evidence for bone-anchored annular closure with greater follow-up durations and (2) update guidance for coding in light of new diagnostic and upcoming current procedural terminology codes. Based on accumulating clinical evidence, the International Society for the Advancement of Spine Surgery reiterates its position that in patients with symptomatic lumbar disc herniation with radiculopathy undergoing primary discectomy with large (≥6 mm wide) annular defects, bone-anchored annular closure may be used to sustain the treatment benefits of discectomy.