Incidence of Revision Surgery After Decompression With vs Without Fusion Among Patients With Degenerative Lumbar Spinal Stenosis

Abstract

IMPORTANCEOnly limited data derived from large prospective cohort studies exist on the incidence of revision surgery among patients who undergo operations for degenerative lumbar spinal stenosis (DLSS). OBJECTIVE To assess the cumulative incidence of revision surgery after 2 types of index operations-decompression alone or decompression with fusion-among patients with DLSS. DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed data from a multicenter, prospective cohort study, the Lumbar Stenosis Outcome Study, which included patients aged 50 years or older with DLSS at 8 spine surgery and rheumatology units in Switzerland between December 2010 and December 2015. The follow-up period was 3 years. Data for this study were analyzed between October and November 2021. EXPOSURES All patients underwent either decompression surgery alone or decompression with fusion surgery for DLSS. MAIN OUTCOMES AND MEASURES The primary outcome was the cumulative incidence of revision operations. Secondary outcomes included changes in the following patient-reported outcome measures: Spinal Stenosis Measure (SSM) symptom severity (higher scores indicate more pain) and physical function (higher scores indicate more disability) subscale scores and the EuroQol Health-Related Quality of Life 5-Dimension 3-Level questionnaire (EQ-5D-3L) summary index score (lower scores indicate worse quality of life). RESULTS A total of 328 patients (165 [50.3%] men; median age, 73.0 years [IQR, 66.0-78.0 years])were included in the analysis. Of these, 256 (78.0%) underwent decompression alone and 72 (22.0%) underwent decompression with fusion. The cumulative incidence of revisions after 3 years of follow-up was 11.3% (95% CI, 7.4%-15.1%) for the decompression alone group and 13.9% (95% CI, 5.5%-21.5%) for the fusion group (log-rank P = .60). There was no significant difference in the need for revision between the 2 groups over time (unadjusted absolute risk difference, 2.

Fusion Is Not a Safeguard to Prevent Revision Surgery in Lumbar Spinal Stenosis

“…Ulrich and colleagues found incidences of revision operations consistent with rates in the Swedish and Norwegian trials and suggested that the use of different decompression techniques may explain the higher rate of revision operations in the US trial . In the Swedish and Norwegian trials, microdecompression was performed, whereas complete laminectomy was performed in the US trial.…”

“…In an observational study based on data from the Swiss Lumbar Stenosis Outcome Study, Ulrich and colleagues evaluated the incidence of revision operation in the first 3 years after surgery for degenerative lumbar spinal stenosis. Their study included patients with and without a concomitant degenerative spondylolisthesis (ie, a forward slip of 1 vertebra relative to the vertebra below).…”

Presentation, Diagnosis, and Management of Lower Back Pain Associated with Spinal Stenosis: A Narrative Review

“…Sometime after the surgery, there are both back and limb pain, as well as neurological deficits. Second lumbar stenosis yields worse results, and patients have better treatment results after 1 surgery than after 2 [ 93 , 94 ]. The frequency of repeated decompression is 9.3–28%.…”

“…The frequency of repeated decompression is 9.3–28%. For every 100 patients, 16 have experienced recurrent stenosis on the operated level or higher [ 93 , 94 ]. The longer the observation time after the original decompressive laminectomy, the higher the percentage of repeated surgeries [ 93 , 94 ].…”

“…For every 100 patients, 16 have experienced recurrent stenosis on the operated level or higher [ 93 , 94 ]. The longer the observation time after the original decompressive laminectomy, the higher the percentage of repeated surgeries [ 93 , 94 ]. Posterolateral stabilization is recommended for patients with lumbar stenosis with coexisting spondylolisthesis requiring decompression [ 94 ].…”