Reoperation rates following lumbar spine surgery and the influence of spinal fusion procedures

Brook I. Martin, Sohail K. Mirza, Bryan A. Comstock, Darryl T. Gray, William Kreuter, Richard (Rick) Deyo

Research output: Contribution to journalArticle

254 Citations (Scopus)

Abstract

STUDY DESIGN. Retrospective cohort study using a hospital discharge registry of all nonfederal acute care hospitals in Washington state. OBJECTIVES. To determine the cumulative incidence of reoperation following lumbar surgery for degenerative disease and, for specific diagnoses, to compare the frequency of reoperation following fusion with that following decompression alone. SUMMARY OF BACKGROUND DATA. Repeat lumbar spine operations are generally undesirable, implying persistent symptoms, progression of degenerative changes, or treatment complications. Compared to decompression alone, spine fusion is commonly viewed as a stabilizing treatment that may reduce the need for additional surgery. However, indications for fusion surgery in degenerative spine disorders remain controversial, and the effects of fusion on reoperation rates are unclear. METHODS. Adults who underwent inpatient lumbar surgery for degenerative spine disorders in 1990-1993 (n = 24,882) were identified from International Classification of Diseases ninth Revision, Clinical Modification codes and then categorized as having either a lumbar decompression surgery or lumbar fusion surgery. We then compared the subsequent incidence of lumbar spine surgery between these groups. RESULTS. Patients who had surgery in 1990-93 had a 19% cumulative incidence of reoperation during the subsequent 11 years. Patients with spondylolisthesis had a lower cumulative incidence of reoperation after fusion surgery than after decompression alone (17.1% vs. 28.0%, P = 0.002). For other diagnoses combined, the cumulative incidence of reoperation was higher following fusion than following decompression alone (21.5% vs. 18.8%, P = 0.008). After fusion surgery, 62.5% of reoperations were associated with a diagnosis suggesting device complication or pseudarthrosis. CONCLUSION. Patients should be informed that the likelihood of reoperation following a lumbar spine operation is substantial. For spondylolisthesis, reoperation is less likely following fusion than following decompression alone. For other degenerative spine conditions, the cumulative incidence of reoperation is higher or unimproved after a fusion procedure compared to decompression alone.

Original languageEnglish (US)
Pages (from-to)382-387
Number of pages6
JournalSpine
Volume32
Issue number3
DOIs
StatePublished - Feb 2007
Externally publishedYes

Fingerprint

Spinal Fusion
Reoperation
Spine
Decompression
Incidence
Spondylolisthesis
Pseudarthrosis
International Classification of Diseases
Registries
Inpatients
Cohort Studies
Retrospective Studies
Equipment and Supplies

Keywords

  • Fusion
  • Lumbar
  • Reoperation
  • Spine
  • Surgery

ASJC Scopus subject areas

  • Physiology
  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Reoperation rates following lumbar spine surgery and the influence of spinal fusion procedures. / Martin, Brook I.; Mirza, Sohail K.; Comstock, Bryan A.; Gray, Darryl T.; Kreuter, William; Deyo, Richard (Rick).

In: Spine, Vol. 32, No. 3, 02.2007, p. 382-387.

Research output: Contribution to journalArticle

Martin, Brook I. ; Mirza, Sohail K. ; Comstock, Bryan A. ; Gray, Darryl T. ; Kreuter, William ; Deyo, Richard (Rick). / Reoperation rates following lumbar spine surgery and the influence of spinal fusion procedures. In: Spine. 2007 ; Vol. 32, No. 3. pp. 382-387.
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abstract = "STUDY DESIGN. Retrospective cohort study using a hospital discharge registry of all nonfederal acute care hospitals in Washington state. OBJECTIVES. To determine the cumulative incidence of reoperation following lumbar surgery for degenerative disease and, for specific diagnoses, to compare the frequency of reoperation following fusion with that following decompression alone. SUMMARY OF BACKGROUND DATA. Repeat lumbar spine operations are generally undesirable, implying persistent symptoms, progression of degenerative changes, or treatment complications. Compared to decompression alone, spine fusion is commonly viewed as a stabilizing treatment that may reduce the need for additional surgery. However, indications for fusion surgery in degenerative spine disorders remain controversial, and the effects of fusion on reoperation rates are unclear. METHODS. Adults who underwent inpatient lumbar surgery for degenerative spine disorders in 1990-1993 (n = 24,882) were identified from International Classification of Diseases ninth Revision, Clinical Modification codes and then categorized as having either a lumbar decompression surgery or lumbar fusion surgery. We then compared the subsequent incidence of lumbar spine surgery between these groups. RESULTS. Patients who had surgery in 1990-93 had a 19{\%} cumulative incidence of reoperation during the subsequent 11 years. Patients with spondylolisthesis had a lower cumulative incidence of reoperation after fusion surgery than after decompression alone (17.1{\%} vs. 28.0{\%}, P = 0.002). For other diagnoses combined, the cumulative incidence of reoperation was higher following fusion than following decompression alone (21.5{\%} vs. 18.8{\%}, P = 0.008). After fusion surgery, 62.5{\%} of reoperations were associated with a diagnosis suggesting device complication or pseudarthrosis. CONCLUSION. Patients should be informed that the likelihood of reoperation following a lumbar spine operation is substantial. For spondylolisthesis, reoperation is less likely following fusion than following decompression alone. For other degenerative spine conditions, the cumulative incidence of reoperation is higher or unimproved after a fusion procedure compared to decompression alone.",
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AU - Martin, Brook I.

AU - Mirza, Sohail K.

AU - Comstock, Bryan A.

AU - Gray, Darryl T.

AU - Kreuter, William

AU - Deyo, Richard (Rick)

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N2 - STUDY DESIGN. Retrospective cohort study using a hospital discharge registry of all nonfederal acute care hospitals in Washington state. OBJECTIVES. To determine the cumulative incidence of reoperation following lumbar surgery for degenerative disease and, for specific diagnoses, to compare the frequency of reoperation following fusion with that following decompression alone. SUMMARY OF BACKGROUND DATA. Repeat lumbar spine operations are generally undesirable, implying persistent symptoms, progression of degenerative changes, or treatment complications. Compared to decompression alone, spine fusion is commonly viewed as a stabilizing treatment that may reduce the need for additional surgery. However, indications for fusion surgery in degenerative spine disorders remain controversial, and the effects of fusion on reoperation rates are unclear. METHODS. Adults who underwent inpatient lumbar surgery for degenerative spine disorders in 1990-1993 (n = 24,882) were identified from International Classification of Diseases ninth Revision, Clinical Modification codes and then categorized as having either a lumbar decompression surgery or lumbar fusion surgery. We then compared the subsequent incidence of lumbar spine surgery between these groups. RESULTS. Patients who had surgery in 1990-93 had a 19% cumulative incidence of reoperation during the subsequent 11 years. Patients with spondylolisthesis had a lower cumulative incidence of reoperation after fusion surgery than after decompression alone (17.1% vs. 28.0%, P = 0.002). For other diagnoses combined, the cumulative incidence of reoperation was higher following fusion than following decompression alone (21.5% vs. 18.8%, P = 0.008). After fusion surgery, 62.5% of reoperations were associated with a diagnosis suggesting device complication or pseudarthrosis. CONCLUSION. Patients should be informed that the likelihood of reoperation following a lumbar spine operation is substantial. For spondylolisthesis, reoperation is less likely following fusion than following decompression alone. For other degenerative spine conditions, the cumulative incidence of reoperation is higher or unimproved after a fusion procedure compared to decompression alone.

AB - STUDY DESIGN. Retrospective cohort study using a hospital discharge registry of all nonfederal acute care hospitals in Washington state. OBJECTIVES. To determine the cumulative incidence of reoperation following lumbar surgery for degenerative disease and, for specific diagnoses, to compare the frequency of reoperation following fusion with that following decompression alone. SUMMARY OF BACKGROUND DATA. Repeat lumbar spine operations are generally undesirable, implying persistent symptoms, progression of degenerative changes, or treatment complications. Compared to decompression alone, spine fusion is commonly viewed as a stabilizing treatment that may reduce the need for additional surgery. However, indications for fusion surgery in degenerative spine disorders remain controversial, and the effects of fusion on reoperation rates are unclear. METHODS. Adults who underwent inpatient lumbar surgery for degenerative spine disorders in 1990-1993 (n = 24,882) were identified from International Classification of Diseases ninth Revision, Clinical Modification codes and then categorized as having either a lumbar decompression surgery or lumbar fusion surgery. We then compared the subsequent incidence of lumbar spine surgery between these groups. RESULTS. Patients who had surgery in 1990-93 had a 19% cumulative incidence of reoperation during the subsequent 11 years. Patients with spondylolisthesis had a lower cumulative incidence of reoperation after fusion surgery than after decompression alone (17.1% vs. 28.0%, P = 0.002). For other diagnoses combined, the cumulative incidence of reoperation was higher following fusion than following decompression alone (21.5% vs. 18.8%, P = 0.008). After fusion surgery, 62.5% of reoperations were associated with a diagnosis suggesting device complication or pseudarthrosis. CONCLUSION. Patients should be informed that the likelihood of reoperation following a lumbar spine operation is substantial. For spondylolisthesis, reoperation is less likely following fusion than following decompression alone. For other degenerative spine conditions, the cumulative incidence of reoperation is higher or unimproved after a fusion procedure compared to decompression alone.

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KW - Lumbar

KW - Reoperation

KW - Spine

KW - Surgery

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