Additional operations after surgery for lumbar disc prolapse

Abstract

Aims Lumbar disc prolapse is a frequent indication for surgery. The few available long-term follow-up studies focus mainly on repeated surgery for recurrent disease. The aim of this study was to analyze all reasons for additional surgery for patients operated on for a primary lumbar disc prolapse. Methods We retrieved data from the Swedish spine register about 3,291 patients who underwent primary surgery for a lumbar disc prolapse between January 2007 and December 2008. These patients were followed until December 2020 to record all additional lumbar spine operations and the reason for them. Results In total, 681 of the 3,291 patients (21%) needed one or more additional operations. More than three additional operations was uncommon (2%; 15/906). Overall, 906 additional operations were identified during the time period, with a mean time to the first of these of 3.7 years (SD 3.6). The most common reason for an additional operation was recurrent disc prolapse (47%; 426/906), followed by spinal stenosis or degenerative spondylolisthesis (19%; 176/906), and segmental pain (16%; 145/906). The most common surgical procedures were revision discectomy (43%; 385/906) and instrumented fusion (22%; 200/906). Degenerative spinal conditions other than disc prolapse became a more common reason for additional surgery with increasing length of follow-up. Most patients achieved the minimally important change (MIC) for the patient-reported outcomes after the index surgery. After the third additional spinal operation, only 20% (5/25) achieved the MIC in terms of leg pain, and 29% (7/24) in terms of the EuroQol five-dimension index questionnaire visual analogue scale. Conclusion More than one in five patients operated on for a lumbar disc prolapse underwent further surgery during the 13-year follow-up period. Recurrent disc prolapse was the most common reason for additional surgery, followed by spinal stenosis and segmental pain. This study shows that additional operations after primary disc surgery are needed more frequently than previously reported, and that the outcome profoundly deteriorates after the second additional operation. The findings from this study can be used in the shared decision-making process. Cite this article: Bone Joint J 2022;104-B(5):627–632.

Impact of the number of previous lumbar operations on patient-reported outcomes after surgery for lumbar spinal stenosis or lumbar disc herniation

“…This association between previous operations and inferior outcomes confirm the findings in previous but smaller studies, including one previous data analysis from NORspine. [3][4][5][6][7][8][9] Only the register-based studies by Zehnder et al 6 and Sigmundsson et al 9 categorized participants based on the number of previous operations.…”

“…Sigmundsson et al 9 analyzed 681 (21%) additional operations after 3,291 primary operations, and reported a stepwise decrease in change scores for NRS leg pain from 5.5 among cases with no previous operations to 1.2 among cases with three previous operations. 9 The corresponding figures in the present study were 4.0 and 2.5. There were similar corresponding observations between the studies for NRS back pain and EQ-5D.…”

“…Both found a dose-response effect of previous surgery: the risk of poor outcome after 12 months increased with the number of previous operations. 6,9 This study aimed to examine whether, and if so to what extent, the number of previous lumbar operations is associated with the outcomes after surgery for lumbar spinal stenosis or lumbar disc herniation.…”

“…3,4 Five registry studies found an association between previous operations and worse outcomes. [5][6][7][8][9] Zehnder et al 6 used data from the Spine Tango Registry and analyzed 4,940 patients operated for degenerative disorders, while Sigmundsson et al 9 used data from the Swedish spine registry (SweSpine) and analyzed 3,291 patients operated for lumbar disc herniation. Both found a doseresponse effect of previous surgery: the risk of poor outcome after 12 months increased with the number of previous operations.…”

Determination of Work Related to Endoscopic Decompression of Lumbar Spinal Stenosis

“…Spondylolisthesis [7] and decompression-induced iatrogenic instability [8] have been recognized has indications for lumbar spinal fusion. Endoscopic decompression surgery is increasingly being used as a less burdensome and simplified alternative to more traditional, open, and minimally invasive decompression techniques [9]. While a formal prospective cohort study is currently underway comparing lumbar endoscopic decompression to open decompression and fusion [10], existing studies suggest that lumbar endoscopic stenosis decompression in the central and lateral canal is associated with a low long-term fusion rate, with one study identifying a rate of 2.7% [11] and another, 8.9% [12].…”