Do You Need a Barricaid After Slipped Disc Surgery?

Several patients due to undergo a lumbar microdiscectomy have recently asked me the same question: should they have a device called the Barricaid fitted? It is a fair question, and an important one. Below I explain what the Barricaid is, how it works, and what the evidence actually tells us about who benefits from it.

Quick answer

The Barricaid is a small implant placed in the disc space during a microdiscectomy to seal a large opening in the disc wall and lower the risk of a recurrent slipped disc. It is only suitable for a small minority of patients: those with an unusually large tear in the disc lining, typically 6 to 10mm wide.

For most people undergoing a microdiscectomy the risk of a recurrent herniation is already low, around 5% in the first year, so the device is usually not needed.

The decision depends on a careful review of your symptoms and a precise measurement of the tear on your MRI scan.

What is the Barricaid device?

The Barricaid is an annular closure device. It is a small implant made of a metal anchor with a fabric-like mesh attached to it. After a surgeon removes the part of a slipped disc that is pressing on a nerve, the Barricaid is used to seal the opening left in the wall of the disc.

Its purpose is to reduce the chance of more disc material slipping out later and causing a recurrent slipped disc, which is also known as a reherniation.

A quick look at the anatomy of a disc

To understand the device, it helps to understand the disc itself. Your spine is a stack of bones called vertebrae, which are the building blocks of the spine. Between each pair of bones sits a disc, which acts as a cushion or shock absorber.

Each disc has two main parts. The centre is a soft, squishy material called the nucleus, often described as having a consistency similar to crab meat. The nucleus is held in place by a tough outer lining called the annulus. Think of the annulus as several layers of a strong, fabric-like material.

When a disc herniates and causes sciatica, the layers of the annulus gradually tear until they split.

This allows some of the inner nucleus to leak out and pinch a nearby nerve, which produces leg pain, numbness or weakness.

What happens during a microdiscectomy?

A microdiscectomy is one of the main treatments for a slipped disc that is pressing on a nerve. I usually approach the spine from the back through a very small incision and work under a microscope to shave away or remove the fragment of nucleus that is pinching the nerve.

The procedure is highly effective at relieving the trapped nerve. The one trade-off is that it leaves a small opening in the annulus, the outer lining of the disc. This means there is a small risk that more material slips out at a later date and causes a recurrent sciatica.

Does the disc heal on its own after surgery?

In most cases, yes. The annulus is made of a substance called collagen. When the body forms scar tissue during the healing process, that scar tissue is also made of collagen. There are different types of collagen, but the result is that the annulus is able to repair itself over time. This natural healing is part of the reason that recurrent herniation is uncommon for most patients.

How does the Barricaid work?

The Barricaid has a metal anchor and a fabric-like mesh wrapped around it. Once the surgeon has removed the offending disc fragment, the metal anchor is secured into the bone of the vertebra just below the disc. The mesh then sits across the opening at the back of the disc and seals it off, acting as a physical barrier to stop further nucleus material escaping.

What does the evidence show?

The main study behind the Barricaid was a trial of more than 500 patients who had large openings in the annulus, confirmed on their MRI scans. The patients were split into two groups: one group had the device inserted and the other did not.

The trial found that the recurrent herniation rate was higher in the group without the device, at around 31%, compared with around 18% in the group that received the device. On the face of it, that is an encouraging result.

The crucial detail is who the trial included. It only enrolled patients whose tear was around 4 to 6mm in height, whose discs were at least 5mm high, and whose annular defect was between 6 and 10mm wide. That is a large tear in the disc lining, and it is relatively unusual.

For context, the part of the disc that is in contact with the spinal canal and the nerves is usually only around 22mm wide. An opening of up to 1cm is therefore a significant proportion of that space, and it is not the picture we see in the majority of herniated discs that we operate on.

Who is the Barricaid actually for?

This is the heart of the matter. Studies show that across microdiscectomies in general, regardless of the size of the herniation, the average reherniation rate is only around 5% within the first 12 months.

The Barricaid trial deliberately selected a specific subgroup of patients who have a higher than usual rate of reherniation, because of an abnormally wide opening in the disc lining. That is why the device is relevant only to a small minority of people undergoing a lumbar microdiscectomy. For most patients, the risk of a recurrent slipped disc is already low and the device is not required.

What are the risks of the Barricaid?

No implant is risk-free. When researchers looked specifically at patients who experienced an adverse event from the Barricaid, the majority of those events involved either the device migrating, which means moving from where it was first placed, or a reherniation of the disc occurring anyway. Around 66% of patients who had an adverse event went on to need further surgery. These risks are part of why careful patient selection matters so much.

My approach to disc surgery

When I operate on a herniated disc, I do not aim to remove all of the disc material aggressively. Studies have shown that aggressive removal can lead to more post-operative pain and a reduced quality of life. Instead, I shave away only the component that is pinching the nerve and then check carefully for any loose fragments that might poke out again.

This conservative, disc-preserving approach is why the Barricaid applies to so few patients in practice. A careful review of your symptoms, how they fit with your scan, and a precise measurement of the width of the tear on your MRI are always the most important steps before deciding whether any additional device is needed.

The bottom line

The Barricaid is a genuinely useful device, but only for a small minority of patients who have an unusually large tear in the disc lining. For most people having a microdiscectomy, where the risk of reherniation is already low, it is not the right choice. The decision should always rest on a thorough assessment of your symptoms and a careful measurement of your MRI scan.

Speak to a consultant spinal neurosurgeon

If you have been told you need a microdiscectomy, or you are weighing up your options for a slipped disc, a careful and personalised assessment is the most important step.

Mr Anthony Ghosh is a Consultant Spinal Neurosurgeon and a UK authority in complex spine care, seeing patients at Harley Street in London and at clinics in Kent and Essex, as well as offering remote consultations for international patients.

To discuss your symptoms and review your MRI scan, book a consultation or visit spinemdt.com.

This article is for general information and education. It is not a substitute for individual medical advice. Always discuss your own diagnosis and treatment options with your surgeon.