Quality of life outcomes after revision lumbar discectomy

Lubelski, Daniel; Şenol, Nurgül; Silverstein, Michael P.; Alvin, Matthew D.; Benzel, Edward C.; Mroz, Thomas E.; Schlenk, Richard

doi:10.3171/2014.10.spine14359

Cited by 20 publications

(12 citation statements)

References 23 publications

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“…[262728] In this study, we found an LDH recurrence rate of 11.24% following standard open surgery. These data are in agreement with those of previous studies where the recurrence rate varies between 5% and 15%,[2029] based on the surgical technique employed. We observed that, even if the collected data were statistically significant (Pearson's Chi-square test < 0.001), there was no statistical correlation between the surgical technique employed (discectomy or herniectomy) and the incidence of recurrence.…”

Section: Discussionsupporting

confidence: 93%

“…It is well known that a direct correlation between clinical outcome and number of surgical interventions performed exists. [294142] Patients with a better clinical outcome are those with a single surgery or with a surgery for a first recurrence. These data are in agreement with those of the analysis we performed in our study (Pearson's χ 2 < 0.001).…”

Section: Discussionmentioning

confidence: 99%

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Recurrent lumbar disc herniation: Is there a correlation with the surgical technique? A multivariate analysis

Landi

Grasso

Mancarella

et al. 2018

J Craniovert Jun Spine

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Purpose:The recurrence of a lumbar disc herniation (LDH) is a common cause of poor outcome following lumbar discectomy. The aim of this study was to assess a potential relationship between the incidence of recurrent LDH and the surgical technique used. Furthermore, we tried to define the best surgical technique for the treatment of recurrent LDH to limit subsequent recurrences.Materials and Methods:A retrospective study was conducted on 979 consecutive patients treated for LDH. A multivariate analysis tried to identify a possible correlation between (1) the surgical technique used to treat the primary LDH and its recurrence; (2) technique used to treat the recurrence of LDH and the second recurrence; and (3) incidence of recurrence and clinical outcome. Data were analyzed with the Pearson's Chi-square test for its significance.Results:In 582 cases (59.4%), a discectomy was performed, while in 381 (40.6%), a herniectomy was undertaken. In 16 cases, a procedure marked as “other” was performed. Among all patients, 110 (11.2%) had a recurrence. Recurrent LDH was observed in 55 patients following discectomy (9.45%), in 45 following herniectomy (11.8%), and in 10 (62.5%) following other surgery. Our data showed that 90.5% of discectomies and 88.2% of the herniectomies had a good clinical outcome, whereas other surgeries presented a recurrence rate of 62.5% (Pearson's χ2< 0.001). No statistical differences were observed between discectomy or herniectomy, for the treatment of the recurrence, and the incidence for the second recurrences (P > 0.05). A significant statistical correlation emerged between the use of other techniques and the incidence for the second recurrences (P < 0.05).Conclusions:The recurrence of an LDH is one of the most feared complications following surgery. Although the standard discectomy has been considered more protective toward the recurrence compared to herniectomy, our data suggest that there is no significant correlation between the surgical technique and the risk of LDH recurrence.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Recurrent lumbar disc herniation: Is there a correlation with the surgical technique? A multivariate analysis

Landi

Grasso

Mancarella

et al. 2018

J Craniovert Jun Spine

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“… 2 Multiple studies have shown that the outcomes for revision spine surgeries are inferior and have a higher rate of complications compared to primary cases. 5 , 6 Identifying modifiable risk factors for recurrent disc herniation may help surgeons decrease the rate of reoperation and therefore improve patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

Smoking Is an Independent Risk Factor of Reoperation Due to Recurrent Lumbar Disc Herniation

Andersen¹,

Smith²,

Støttrup³

et al. 2017

Global Spine Journal

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Study Design:Retrospective cohort study.Objectives:The purpose of the present study is to determine if age, gender, smoking status, and body mass index (BMI) are significant risk factors of symptomatic recurrent lumbar disc herniation (rLDH) leading to reoperation.Methods:A cohort of 1378 consecutive patients who underwent discectomy for LDH from June 2010 to January 2015 at our institution were included. Patients who underwent reoperation due to rLDH prior to August 2015 were identified. Data on reoperations, age, gender, smoking status, and BMI were collected from our database. A comparison of age, gender, smoking status, and BMI was made between the controls (non-rLDH) and the cases (rLDH group). Binary logistic regression was performed to determine whether age, gender, smoking status, and BMI were independent risk factors for rLDH.Results:Patients in the non-rLDH group (48.2 years) were older than the rLDH group (44.7 years; P = .013). Gender distribution (54.8% vs 48.5% males; P = .222) and BMI (26.6 vs 26.6; P = .458) were similar between the 2 groups. A significantly higher prevalence of smokers was found in the rLDH group (33.1% vs 51.5%; P < .001). Binary logistic regression analysis showed that smoking was an independent risk factor of rLDH (odds ratio = 2.12; 95% confidence interval = 1.39-3.15; P < .001).Conclusions:Neither age, BMI, nor gender had any statistical significant association with the risk of rLDH. Smoking was associated with higher risk of reoperation due to rLDH.

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“…We selected 3.0 as the optimal MCID for PHQ-9 (based on calculated SEM), 27,28 as opposed to a value of 5, which has been used for analysis in a number of other studies. [36][37][38][39][40] However, few studies referencing this previous value provided direct evidencebased calculations. Lo ¨we et al's study is one of the few to provide statistically sound establishment of an MCID threshold of 5 for PHQ-9 and is often cited by others.…”

Section: Resultsmentioning

confidence: 99%

The Minimum Clinically Important Difference for Patient Health Questionnaire-9 in Minimally Invasive Transforaminal Interbody Fusion

Lynch

Elliot

Jenkins

et al. 2020

Spine

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Study Design. Retrospective cohort. Objective. To investigate and establish minimum clinically important differences (MCID) for Patient Health Questionnaire-9 (PHQ-9) among patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). Summary of Background. Spine surgery is linked to postoperative improvements in anxiety, depression, and mental health. These improvements have been documented using patientreported outcome measures such as PHQ-9. Few studies evaluated the clinical significance of PHQ-9 for lumbar spine surgery. Methods. Patients who underwent single-level, primary MIS TLIF from 2015 to 2017 were retrospectively reviewed in a prospective database. Patients with incomplete preoperative and 2-year postoperative PHQ-9 surveys were excluded. Demographic and perioperative characteristics were recorded. PHQ-9, 12-Item Short Form (SF-12), and Veterans RAND 12-Item Health Survey (VR-12) Mental Component Summary (MCS) were collected at preoperative, 6-week, 12-week, 6-month, 1-year, and 2-year intervals. MCID was calculated using anchor and distribution-based methods. SF-12 served as an anchor. MCID was assessed using mean change methodology, four receiver operating characteristic curve assessments, and standard error measurement. Cutoff values were selected from receiver operating characteristic curve analysis. MCID achievement rates for all patient-reported outcome measures were calculated. Results. A total of 139 patients met inclusion criteria, with a mean age of 55 years and 39% females. The most common spinal pathology was radiculopathy (92%). MCID analysis revealed the following ranges of values: 2.0 to 4.8 (PHQ-9), 6.7 to 12.1 (SF-12 MCS), and 7.5 to 15.9 (VR-12 MCS). Final MCID thresholds were 3.0 (PHQ-9), 9.1 (SF-12 MCS), and 8.1 (VR-12 MCS). MCID achievement at 2-years for PHQ-9, SF-12 MCS, and VR-12 MCS was 89.2%, 85.6%, and 84.9% respectively. Conclusion. Our 2-year postoperative MCID analysis is the first mental health calculation from an MIS TLIF cohort. We report a 2-year MCID value for PHQ-9 of 3.0 (2.0-4.8). MCID values for mental health instruments are important for determining overall success of lumbar spine surgery.

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Quality of life outcomes after revision lumbar discectomy

Cited by 20 publications

References 23 publications

Recurrent lumbar disc herniation: Is there a correlation with the surgical technique? A multivariate analysis

Recurrent lumbar disc herniation: Is there a correlation with the surgical technique? A multivariate analysis

Smoking Is an Independent Risk Factor of Reoperation Due to Recurrent Lumbar Disc Herniation

The Minimum Clinically Important Difference for Patient Health Questionnaire-9 in Minimally Invasive Transforaminal Interbody Fusion

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