Reply to the letter to the editor of E. Shiban and B. Meyer regarding “Endplate changes after lumbar discectomy with and without implantation of an annular closure device” by Barth M et al., (Acta Neurochir (Wien) 2018 Apr;160(4):855–862)
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We thank the authors for their interest in our original submission  and the subsequent letter. We had reported on the incidence and size of end plate changes (EPC) 12 months after microdiscectomy with (n = 242) or without (n = 251) implantation of an annulus closure device (ACD). EPC increased in both groups, but were significantly more pronounced after additional ACD implantation. Presence and growth of EPC, however, was not correlated with low back pain or ODI.
The authors of the letter hypothesize causality between the presence of low virulent anaerobic bacteria and EPC, which is obviously based on a single case of ACD anchor loosening they have encountered . However, current evidence clearly speaks against the authors’ speculations:
First, there was not a single case of implant loosening in our series of 242 patients that would resemble the authors’ case report . EPC should not be intermingled with aseptic implant failure or loosening, as they generally occur...
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