Risk Factors for Reoperation in Patients Treated Surgically for Intervertebral Disc Herniations: A Subanalysis of the Eight-Year Data from the SPORT Trial

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

doi:10.1016/j.spinee.2014.08.242

Cited by 31 publications

(41 citation statements)

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“…Endoscopic discectomy for recurrent disc prolapse is, in our opinion, a valuable alternative to open microdiscectomy or even to minimally invasive techniques. In our series, a satisfactory outcome was obtained for all the patients, with few complications, a negligible post-operative pain, and a faster return to normal daily activities (Leven et al, 2015). Also, we believe that the risk of iatrogenic mechanical instability might be reduced with this technique.…”

Section: Resultssupporting

confidence: 51%

Endoscopic Approach Technique for Recurrent Lumbar Prolapsed Disc

2019

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Introduction: Recurrent disc after lumbar discectomy is not uncommon, with most of the patients requiring a new surgery. A greater bone decompression and scar tissue dissection become necessary with the new procedure, resulting in a higher chance of postoperative complications. Recently, many surgeons have begun to treat recurrent disc with endoscopic approaches, in order to reach the prolapsed disc avoiding tissue dissection. We present our up-to-dated experience on the treatment of recurrent disc by endoscopic technique. Material and methods: We prospectively collected 30 patients treated for recurrent lumbar disc prolapse, from May 2016 to December 2017, with an endoscopic procedure. We collected data on age, sex, location, diagnosis, leg pain by VAS, and degree of disability via the Oswestry Disability Index (ODI), and if any adverse events occurred. All patients underwent an ODI (Oswestry Disability Index) and a VAS (Visual Analogue Scale) questionnaire before the operation and after 3, 6 and 15 months [3-6] at the follow-up visit. No patients were lost at follow-up. Patients characteristics: Age at presentation ranged between 23 and 78 years with a male to female ratio of 1.5 to 1. The level treated more was L4-L5. In all cases, we performed transforaminal route access, except for two, where an interlaminar approach was necessary because of the disc fragment location. Twenty-six cases had been operated previously by microsurgical access and the remaining by an endoscopic technique. In one case the disc had recurred for a second time, requiring open revision surgery. Results: Median operative time was 52 minutes (range 44 to 79 minutes). After a median follow up of 15 months (range 15-24 months) 93% of patients were pain-free. Pain by VAS ranged from a mean value of 6.3 at admission to 1.9 at 15 months of follow-up. ODI scores went from a mean preoperative value of 59.8% to 14.6% at the same followup. Four patients experienced transient paresthesia along the dermatomeric distribution of the involved nerve, while 3 had an intraoperative dural tear. One patient had to undergo new revision surgery for a disc recurrence. No late adverse events occurred. Conclusions: Endoscopic discectomy might be a valuable procedure for recurrent lumbar disk prolapse treatment. Our results showed good outcomes with only a few transient complications and less postoperative pain. Also, iatrogenic mechanical instability might be avoided with this technique.

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Section: Resultssupporting

confidence: 51%

Endoscopic Approach Technique for Recurrent Lumbar Prolapsed Disc

2019

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“…Moreover, no cases required a subsequent revision procedure, and long-term clinical results including reoperation rate were favorable as compared with the results of conventional open diskectomy reported previously (►Table 5). [18][19][20] We conclude that MED is a wellbalanced technique that offers both reduced invasiveness and high reliability in the treatment of lumbar disk herniation. Recurrence of disk herniation, reported in 5 to 15% of patients, is one of the major causes of reoperation.…”

Section: Discussionmentioning

confidence: 80%

Long-Term Outcome of Microendoscopic Diskectomy for Lumbar Disk Herniation. A Clinical Study of Consecutive 112 Cases with More than 5-Year Follow-Up

Yoshimoto

Iesato

Terashima

et al. 2017

J Neurol Surg A Cent Eur Neurosurg

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Clinical results and recurrence rate after microendoscopic diskectomy (MED) with long-term follow-up is still unclear, in spite of its relatively long history. A total of 112 who underwent MED participated in this study. Operative time, blood loss, serum C-reactive protein (CRP), creatinekinase (CK), and visual analog scale (VAS) were evaluated as indexes of surgical invasiveness. The 36-Item Short Form Survey Instrument (SF-36), Japanese Orthopaedic Association (JOA) score, patient satisfaction, and recurrence were also evaluated with a follow-up of at least 5 years. The mean operative time was 86.7 minutes, and the mean blood loss was 35.7 mL. The mean CRP on postoperative day 3 and CK on the first postoperative day was 0.72 mg/dL and 224.6 IU/L, respectively, and VAS to assess surgical site pain on the first postoperative day was 24.9 mm on average. The improvement rate in the JOA score was 68.7%. The physical component summary of SF-36 in norm-based scoring was improved from 23.4 to 48.6. Overall, 90.8% of patients evaluated their response to the surgery as extremely satisfied or satisfied. The recurrence rate was 10.5%, and reoperation was performed in 7.9% of patients. MED is a technique that offers both reduced invasiveness and good long-term clinical results.

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“…20 Degenerative scoliosis, excessive body weight, and number of spinal levels involved are also notable risk factors for reoperation. 21,22 Intraoperative blood loss, combined comorbidities, 23 and preoperative hemoglobin level are possible risk factors according to previous studies. 24,25 Our study showed a strong relationship between the number of diseased segments and time to re-surgery; however, age and sex were not significant risk factors in the present study.…”

Section: Discussionmentioning

confidence: 94%

Comparison of Reoperation after Fusion and after Decompression for Degenerative Lumbar Spinal Stenosis: A Single-Center Experience of 987 Cases

Kim

Park

Lim

et al. 2020

J Neurol Surg A Cent Eur Neurosurg

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Background and Study Aim Reoperation for lumbar spinal stenosis (LSS) is technically challenging. Studies comparing preoperative risk factors and reoperation outcomes between spinal fusion and spinal decompression are limited. Thus this study compared fusion and decompression with respect to reoperation rates, preoperative factors related to re-surgery, and clinical outcomes. Patients and Methods This retrospective cohort study included prospectively collected data from patients who underwent revision surgeries for degenerative LSS between May 2001 and March 2015. The reoperation rate, risk factors (proportional hazards analysis of index surgery), surgery type, main reason for revision, and final clinical outcomes (pain, quality-of-life modification, patient satisfaction, and complication rate) were analyzed and compared between the fusion and decompression surgeries. Results Among 987 cases during 13 years, 25 cases of reoperation after fusion and 23 cases of reoperation after decompression were identified, accounting for reoperation rates of 5.88% and 4.00%, respectively. Combined comorbidities (hazard ratio [HR]: 1.98 for fusion; multilevel involvement [with fusion, HR: 2.92; decompression, HR: 1.95]) were strongly correlated with preoperative demographic risk factor for each procedure. The main reason for reoperation in fusion cases was proximal junctional kyphosis (40%) and implant failure (20%), and in decompression cases, recurrent lesions (48.8%) and incomplete surgery (17.4%) An additional fusion after initial fusion and re-decompression without fusion after initial decompression were the most common surgical procedure. Back pain and patient satisfaction after fusion were better compared with those after decompression. Conclusion The reoperation rate, preoperative risk factors, reason for revision, reoperation type, clinical outcomes, patient satisfaction, and time interval between index and re-surgery were different between the primary fusion and primary decompression. A better understanding of disease pathophysiology and surgical procedure characteristics will facilitate improvement in disease management and the development of treatment strategies.

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Risk Factors for Reoperation in Patients Treated Surgically for Intervertebral Disc Herniations: A Subanalysis of the Eight-Year Data from the SPORT Trial

Cited by 31 publications

References 0 publications

Endoscopic Approach Technique for Recurrent Lumbar Prolapsed Disc

Endoscopic Approach Technique for Recurrent Lumbar Prolapsed Disc

Long-Term Outcome of Microendoscopic Diskectomy for Lumbar Disk Herniation. A Clinical Study of Consecutive 112 Cases with More than 5-Year Follow-Up

Comparison of Reoperation after Fusion and after Decompression for Degenerative Lumbar Spinal Stenosis: A Single-Center Experience of 987 Cases

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