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Recurrent Lumbar Disk Herniation and Revision Surgery Rates After Single-Level Lumbar Microdiscectomy in the Military
Donald F Colantonio1, Donald R Fredericks, Michael J Elsenbeck
1From the Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda MD (Colantonio, Fredericks, Cady, Schlaff, Helgeson, and Wagner), the Department of Orthopaedic Surgery, Uniformed Services University of Health Sciences, Bethesda MD (Colantonio, Fredericks, Elsenbeck, Schlaff, Christensen, Helgeson, and Wagner), the Department of Orthopaedic Surgery, Martin Army Community Hospital, Ft. Benning GA (Elsenbeck), and the Department of Orthopaedic Surgery, Naval Hospital Pensacola, Pensacola FL (Christensen).
Background:
Lumbar microdiscectomy remains the most commonly performed surgical procedure for symptomatic lumbar disk herniation (LDH). Despite advances in surgical techniques, recurrent LDH (rLDH) ranges from 5% to 24%, representing the most common cause of surgical failure and revision surgery. Optimal treatment of reherniation remains controversial. In addition, no previously reported large database studies capture the rLDH rate in patients who did not undergo revision surgery. The purpose of this study was to determine the recurrence and revision surgery rate, time to revision surgery, and type of revision procedures performed after single-level diskectomy for LDH.
Methods:
Using the Military Health System Data Repository, we retrospectively identified patients who underwent single-level microdiscectomy between October 2012 and December 2016. Electronic health records were reviewed to determine demographic data, rLDH rate, revision surgery rate, and type of revision surgery. Rates of subsequent procedures involving instrumented fusion and complications were recorded.
Results:
Three thousand three hundred eighty-eight single-level microdiscectomies were included in the study. The same-level rLDH rate was 22.8%. A total of 396 revision surgeries (11.7%) were performed, with 274 revision microdiscectomies (69.2%) and 122 fusions (30.8%). Thirty-eight patients required additional surgical treatment. Overall, 138 patients (4.1%) progressed to lumbar arthrodesis after single-level microdiscectomy. Of those requiring more than one revision, 16 (42.1%) required an arthrodesis. All-cause complication during the index microdiscectomy was associated with greater reherniation risk (odds ratio 2.1, P < 0.001).
Conclusion:
This retrospective study demonstrates a same-level recurrence rate of 22.8% with an 11.7% revision surgery rate. Within this group, 9.6% would require two or more revision surgeries and 42.1% of these revision microdiscectomy patients would ultimately undergo a lumbar arthrodesis at the same level as the initial disk herniation. Our findings characterize the lumbar disk reherniation population in the military health system, with major implications for the prognosis and treatment strategy of these commonly treated injuries.
Insights
Lumbar microdiscectomy for lumbar disk herniation (LDH) has a 22.8% recurrence rate. Over 11% of patients required revision surgery, with many progressing to lumbar fusion.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Spinal Surgery
Background:
- Lumbar microdiscectomy is the primary surgical treatment for symptomatic lumbar disk herniation (LDH).
- Recurrent LDH (rLDH) after initial surgery occurs in 5-24% of cases, often necessitating revision surgery.
- Optimal management strategies for rLDH remain a subject of debate.
Purpose of the Study:
- To determine the recurrence and revision surgery rates following single-level microdiscectomy for LDH.
- To analyze the time to revision surgery and the types of procedures performed.
- To investigate the rate of subsequent lumbar arthrodesis after initial microdiscectomy.
Main Methods:
- Retrospective analysis of 3,388 single-level microdiscectomies from the Military Health System Data Repository (October 2012 - December 2016).
- Review of electronic health records for demographic data, rLDH, revision surgery rates, and procedure types.
- Documentation of rates for instrumented fusion and complications.
Main Results:
- A same-level rLDH rate of 22.8% was observed.
- 11.7% of patients (396) underwent revision surgery, including 69.2% revision microdiscectomies and 30.8% fusions.
- 4.1% of all patients progressed to lumbar arthrodesis, with 42.1% of those needing multiple revisions ultimately undergoing fusion.
Conclusions:
- Single-level microdiscectomy for LDH has a high same-level recurrence rate (22.8%) and revision surgery rate (11.7%).
- A significant proportion of patients undergoing revision surgery eventually require lumbar arthrodesis.
- Findings provide critical data for prognosis and treatment strategies for rLDH within the military health system.
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