Risk Factors for Reoperation in Patients Treated Surgically for Intervertebral Disc Herniation

Leven, Dante M.; Passias, Peter G.; Errico, Thomas J.; Lafage, Virginie; Bianco, Kristina; Lee, Alexandra; Lurie, Jon D.; Tosteson, Tor D.; Zhao, Wenyan; Spratt, Kevin F.; Morgan, Tamara S.; Gerling, Michael C.

doi:10.2106/jbjs.n.01287

Cited by 94 publications

(64 citation statements)

References 29 publications

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“…Although counterintuitive, this finding was seen in an earlier study of LBP recurrence after SLDH using similar methods to our study 4 . Older age is associated with lower reoperation rates for SLDH patients in SPORT 25 and elsewhere 26 , which may be explained by a tendency for surgeons to be less inclined to reoperate for older patients with attendant comorbidities. However, another explanation for lower reoperation rates in older adults is that older adults are less likely to develop recurrent symptoms 25 .…”

Section: Discussionmentioning

confidence: 99%

“…Older age is associated with lower reoperation rates for SLDH patients in SPORT 25 and elsewhere 26 , which may be explained by a tendency for surgeons to be less inclined to reoperate for older patients with attendant comorbidities. However, another explanation for lower reoperation rates in older adults is that older adults are less likely to develop recurrent symptoms 25 . It is possible that putative LBP mechanisms mediated by disc-related structures (such as internal disc disruption, nerve ingrowth into annular fissures, endplate changes, and posterior longitudinal ligament innervation, etc.)…”

Section: Discussionmentioning

confidence: 99%

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Pain Recurrence After Discectomy for Symptomatic Lumbar Disc Herniation

Suri

Pearson

Zhao

et al. 2017

Spine

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Study Design Secondary analysis of data from a concurrent randomized trial and cohort study. Objective To determine risks and predictors of recurrent pain following standard open discectomy for subacute/chronic symptomatic lumbar disc herniation (SLDH). Summary of Background Data Most prior studies of recurrence after discectomy do not explicitly define pain resolution and recurrence, and do not account for variable durations of time at-risk for recurrence. Methods We used survival analysis methods to examine predictors of leg pain recurrence. For individuals with initial resolution of leg pain, we defined recurrent leg pain as having leg pain, receiving lumbar epidural steroid injections, or undergoing lumbar surgery subsequent to initial leg pain resolution. We calculated cumulative risks of leg pain recurrence using Kaplan-Meier survival curves, and examined predictors of recurrence using Cox proportional hazards models. We used similar methods to examine LBP recurrence. Results 1- and 3-year cumulative risks of leg pain recurrence were 20% and 45%, respectively. 1- and 3- year leg pain recurrence risks were substantially lower in participants with complete initial resolution of leg pain (17% and 41%, respectively) than in those without (27% and 54%, respectively). In multivariate analyses, complete leg pain resolution (adjusted hazard ratio [aHR] 0.69 [95% CI 0.52-0.90]), smoking (aHR 1.68 [95% CI 1.22-2.33]), and depression (aHR 1.74 [95% CI 1.18-2.56]) predicted leg pain recurrence. The 1- and 3-year risk of LBP recurrence was 29% and 65%, respectively. LBP recurrence risk at 3 years was substantially lower in participants with complete initial resolution of LBP than in those without, but not at 1 year. Conclusions Recurrence of leg pain and LBP is common after discectomy for SLDH. Cumulative risks of both leg pain and LBP recurrence were generally lower in participants achieving complete initial resolution of pain post-discectomy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pain Recurrence After Discectomy for Symptomatic Lumbar Disc Herniation

Suri

Pearson

Zhao

et al. 2017

Spine

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“…In fact, the single best factor correlated with good clinical outcomes from discectomy is the absence of reherniation [5]. Unfortunately, IDH patients treated surgically are up to 10 times more likely to have a future spine operation compared to the general population, and 62% of reoperations after discectomy can be attributed to reherniation [6, 7]. Overall, reherniation rates of surgically treated IDH patients in recent studies vary from 3%–18% [8, 9].…”

Section: Introductionmentioning

confidence: 99%

Reoperation for Recurrent Intervertebral Disc Herniation in the Spine Patient Outcomes Research Trial

Abdu

Pearson

et al. 2017

Spine

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Study Design This study was a post-hoc subgroup analysis of prospectively collected data in the Spine Patient Outcomes Research Trial (SPORT). Objective Determine the risk factors for and to compare the outcomes of patients undergoing revision disc excision surgery in SPORT. Summary of background data Risk factors for reherniation and outcomes after revision surgery have not been well-studied. This information is critical for proper patient counseling and decision making. Methods Patients who underwent primary discectomy in the SPORT intervertebral disc herniation cohort were analyzed to determine risk factors for undergoing revision surgery. Risk factors for undergoing revision surgery for reherniation were evaluated using univariate and multivariate analysis. Primary outcome measures consisted of Oswestry Disability Index (ODI), the Sciatica Bothersomeness index (SBI), and the Short Form 36 (SF-36) at six weeks, three months, six months, and yearly to four years. Results Of 810 surgical patients patients, 74 (9.1%) received revision surgery for rehernation. Risk factors for reherniation included: younger age (HR 0.96 (0.94–0.99)), lack of a sensory deficit (HR 0.61 (0.37–0.99)) lack of motor deficit (HR 0.54 (0.32–0.91)) and higher baseline ODI score (HR 1.02 (1.01–1.03)). The time adjusted mean improvement from baseline to four years was less for the reherniation group on all outcome measures (BP 39.5 vs. 44.9, p=0.001; PF 37.1 vs. 44.5, p<0.001; ODI 33.9 vs. 38.3, p <0.001; SBI 8.7 vs. 10.5, p<0.001). At four years, only SBI (−9 vs. −11.4, p=0.002) was significantly lower in the reherniation group. Conclusions Younger patients with higher baseline disability without neurological deficit are at increased risk of undergoing revision surgery for reherniation. Those considering revision surgery for reherniation will likely improve significantly following surgery, but possibly not as much as with primary discectomy.

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“…Nowadays, a "limited" discectomy even microendoscopic discectomy that excising only fragments with minimal invasive exposure was more and more widely used to minimize the in uence to the segmental stability [3]. However, the incidence of reoperation persists at 13% to 25% after the limited discectomy procedure, mainly due to the symptomatic recurrent disc herniation presenting as the primary contributor [4,5]. The annular defect because of the primary LDH or discectomy, especially for cases with large and massive defect (≥ 6 mm), is considered as the main reason for recurrent disc herniation [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Is annular repair technique useful for reducing reherniation and reoperation after limited discectomy

Zhang¹,

Tang²,

Jiang³

et al. 2020

Preprint

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BackgroundThe annular defect because of the primary lumbar disc herniation (LDH) or surgical procedure is considered as a main reason for recurrent herniation and eventually reoperation. Efforts to close the defect with annular repair devices have been attempted several times but the results were controversial. The present aims to detect whether the annular repair techniques were useful for reducing the re-herniation and re-operation rate after limited discectomy for LDH patients.MethodsThe Pubmed, Cochrane library, and Embase databases were searched to retrieve relevant studies published before January 1, 2020. Continuous variables were compared by calculating the standard difference of the means (SDM), whereas categorical dichotomous variables were assessed using relative risks (RRs). A random-effects model was used if the heterogeneity statistic was significant; otherwise, a fixed-effects model was used. ResultsA total of 10 researches were suitable for the meta-analysis, including four different repair techniques and a total of 1907 participates (1203 treated and 704 control). In comparison with the control group, there was no statistical difference with the ODI, VAS-leg, and VAS-back scales for patients treated with annular repair. However, the use of an annular repair device was associated with a significant reduction in the re-herniation (p=0.004) and re-operation (0.004) rates. There was no difference between the groups with the perioperative complications, but much more device related long term complications happened in the annual repair group (p=0.031) though it still decreased the overall re-operation rate significantly (p=0.006).ConclusionOur results demonstrated that the use of an annular repair device was safe and useful for reducing re-herniation and re-operation rates.

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Risk Factors for Reoperation in Patients Treated Surgically for Intervertebral Disc Herniation

Cited by 94 publications

References 29 publications

Pain Recurrence After Discectomy for Symptomatic Lumbar Disc Herniation

Pain Recurrence After Discectomy for Symptomatic Lumbar Disc Herniation

Reoperation for Recurrent Intervertebral Disc Herniation in the Spine Patient Outcomes Research Trial

Is annular repair technique useful for reducing reherniation and reoperation after limited discectomy

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