Revision surgery following operations for lumbar stenosis

Richard (Rick) Deyo, Brook I. Martin, William Kreuter, Jeffrey G. Jarvik, Heather Angier, Sohail K. Mirza

Research output: Contribution to journalArticle

78 Citations (Scopus)

Abstract

Background: For carefully selected patients with lumbar stenosis, decompression surgery is more efficacious than nonoperative treatment. However, some patients undergo repeat surgery, often because of complications, the failure to achieve solid fusion following arthrodesis procedures, or persistent symptoms. We assessed the probability of repeat surgery following operations for the treatment of lumbar stenosis and examined its association with patient age, comorbidity, previous surgery, and the type of surgical procedure. Methods: We performed a retrospective cohort analysis of Medicare claims. The index operation was performed in 2004 (n = 31,543), with follow-up obtained through 2008. Operations were grouped by complexity as decompression alone, simple arthrodesis (one or two disc levels and a single surgical approach), or complex arthrodesis (more than two disc levels or combined anterior and posterior approach). Reoperation rates were calculated for each follow-up year, and the time to reoperation was analyzed with proportional hazards models. Results: The probability of repeat surgery fell with increasing patient age or comorbidity. Aside from age, the strongest predictor was previous lumbar surgery: at four years the reoperation rate was 17.2% among patients who had had lumbar surgery prior to the index operation, compared with 10.6% among those with no prior surgery (p <0.001). At one year, the reoperation rate for patients who had beenmanaged with decompression alone was slightly higher than that for patients who had beenmanaged with simple arthrodesis, but by four years the rates for these two groups were identical (10.7%) and were lower than the rate for patients who had been managed with complex arthrodesis (13.5%) (p <0.001). This difference persisted after adjusting for demographic and clinical features (hazard ratio for complex arthrodesis versus decompression 1.56, 95% confidence interval, 1.26 to 1.92). A device-related complication was reported at the time of 29.2% of reoperations following an initial arthrodesis procedure. Conclusions: The likelihood of repeat surgery for spinal stenosis declined with increasing age and comorbidity, perhaps because of concern for greater risks. The strongest clinical predictor of repeat surgery was a lumbar spine operation prior to the index operation. Arthrodeses were not significantly associated with lower rates of repeat surgery after the first postoperative year, and patients who had had complex arthrodeses had the highest rate of reoperations. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Original languageEnglish (US)
Pages (from-to)1979-1986
Number of pages8
JournalJournal of Bone and Joint Surgery - Series A
Volume93
Issue number21
DOIs
StatePublished - Nov 2 2011

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Reoperation
Arthrodesis
Pathologic Constriction
Decompression
Comorbidity
Spinal Stenosis
Medicare
Proportional Hazards Models
Spine
Cohort Studies
Therapeutics
Demography
Confidence Intervals
Equipment and Supplies

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Deyo, R. R., Martin, B. I., Kreuter, W., Jarvik, J. G., Angier, H., & Mirza, S. K. (2011). Revision surgery following operations for lumbar stenosis. Journal of Bone and Joint Surgery - Series A, 93(21), 1979-1986. https://doi.org/10.2106/JBJS.J.01292

Revision surgery following operations for lumbar stenosis. / Deyo, Richard (Rick); Martin, Brook I.; Kreuter, William; Jarvik, Jeffrey G.; Angier, Heather; Mirza, Sohail K.

In: Journal of Bone and Joint Surgery - Series A, Vol. 93, No. 21, 02.11.2011, p. 1979-1986.

Research output: Contribution to journalArticle

Deyo, RR, Martin, BI, Kreuter, W, Jarvik, JG, Angier, H & Mirza, SK 2011, 'Revision surgery following operations for lumbar stenosis', Journal of Bone and Joint Surgery - Series A, vol. 93, no. 21, pp. 1979-1986. https://doi.org/10.2106/JBJS.J.01292
Deyo, Richard (Rick) ; Martin, Brook I. ; Kreuter, William ; Jarvik, Jeffrey G. ; Angier, Heather ; Mirza, Sohail K. / Revision surgery following operations for lumbar stenosis. In: Journal of Bone and Joint Surgery - Series A. 2011 ; Vol. 93, No. 21. pp. 1979-1986.
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N2 - Background: For carefully selected patients with lumbar stenosis, decompression surgery is more efficacious than nonoperative treatment. However, some patients undergo repeat surgery, often because of complications, the failure to achieve solid fusion following arthrodesis procedures, or persistent symptoms. We assessed the probability of repeat surgery following operations for the treatment of lumbar stenosis and examined its association with patient age, comorbidity, previous surgery, and the type of surgical procedure. Methods: We performed a retrospective cohort analysis of Medicare claims. The index operation was performed in 2004 (n = 31,543), with follow-up obtained through 2008. Operations were grouped by complexity as decompression alone, simple arthrodesis (one or two disc levels and a single surgical approach), or complex arthrodesis (more than two disc levels or combined anterior and posterior approach). Reoperation rates were calculated for each follow-up year, and the time to reoperation was analyzed with proportional hazards models. Results: The probability of repeat surgery fell with increasing patient age or comorbidity. Aside from age, the strongest predictor was previous lumbar surgery: at four years the reoperation rate was 17.2% among patients who had had lumbar surgery prior to the index operation, compared with 10.6% among those with no prior surgery (p <0.001). At one year, the reoperation rate for patients who had beenmanaged with decompression alone was slightly higher than that for patients who had beenmanaged with simple arthrodesis, but by four years the rates for these two groups were identical (10.7%) and were lower than the rate for patients who had been managed with complex arthrodesis (13.5%) (p <0.001). This difference persisted after adjusting for demographic and clinical features (hazard ratio for complex arthrodesis versus decompression 1.56, 95% confidence interval, 1.26 to 1.92). A device-related complication was reported at the time of 29.2% of reoperations following an initial arthrodesis procedure. Conclusions: The likelihood of repeat surgery for spinal stenosis declined with increasing age and comorbidity, perhaps because of concern for greater risks. The strongest clinical predictor of repeat surgery was a lumbar spine operation prior to the index operation. Arthrodeses were not significantly associated with lower rates of repeat surgery after the first postoperative year, and patients who had had complex arthrodeses had the highest rate of reoperations. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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