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Table 3 Introduction of a new classification of ACD associated EPC. The EPC score ranges from 1 to 4 and assesses anchor localization (superior/inferior) and size of EPC (< 1cm3 / > 1cm3) as criteria. Scores were defined as follows: grade 1 includes patients with ACD implanted on inferior EP and EPCs of < 1 cm3, grade 2 have an ACD in the superior EP and EPCs < 1 cm3, grade 3 received ACD in inferior EP and EPCs > 1 cm3, and finally maximum grade 4 if ACD is in the superior EP and the EPCs are > 1 cm3. ACD = Annular closure device

From: Incidence and clinical impact of vertebral endplate changes after limited lumbar microdiscectomy and implantation of a bone-anchored annular closure device

  Localization of the anchor Size of the EPC
EPC classification
 Grade 1 Caudal  < 1 cm3
 Grade 2 Cranial  < 1 cm3
 Grade 3 Caudal  > 1 cm3
 Grade 4 Cranial  > 1 cm3