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Updated: Sep 18, 2025
Full-Endoscopic Transforaminal Approach for Lumbar Discectomy
Published on: September 8, 2023
Reoperation Rates After Lumbar Discectomy in Pediatric Patients
Andy M Liu1, Adeesya Gausper2, Suhas Etigunta1
1Department of Orthopaedic Surgery.
Insights
Pediatric lumbar disc herniation (LDH) surgery has an 11.8% reoperation rate within 5 years. Obesity and comorbidities increase reoperation risk in young patients.
Area of Science:
- Neurosurgery
- Pediatric Orthopedics
- Spinal Surgery
Background:
- Lumbar disc herniation (LDH) is rare in children but can cause pain and neurological deficits.
- Surgical outcomes for pediatric discectomy require further investigation.
Purpose of the Study:
- To analyze reoperation rates and identify risk factors following discectomy in pediatric patients.
- To provide data for clinical decision-making and patient counseling.
Main Methods:
- A national insurance claims database (PearlDiver) was queried for pediatric patients (<21 years) undergoing discectomy.
- Reoperations were tracked within 5 years, with analyses including Kaplan-Meier survival and Cox proportional regression.
- Factors influencing survival post-primary discectomy were analyzed.
Main Results:
- The overall pediatric reoperation rate was 11.8% within 5 years.
- Reoperation rates were higher in older pediatric patients (18-21 years) compared to younger ones (<18 years).
- Obesity and higher Elixhauser Comorbidity Index were inversely correlated with survival and increased reoperation risk.
Conclusions:
- Pediatric discectomy has an 11.8% reoperation rate, with higher risk in older adolescents.
- Obesity and comorbidities are significant risk factors for reoperation in pediatric LDH patients.
- This study offers large-scale, real-world data to guide surgical management of pediatric microdiscectomy.
Background:
Lumbar disc herniation (LDH) is uncommon in the pediatric population but can cause significant low-back or radicular pain and, at times, neurological deficits. We aimed to study discectomy operations in pediatric patients to provide insight into surgical outcomes that may inform clinical decision-making and patient counseling.
Methods:
A national insurance claims database (PearlDiver) was queried to identify pediatric patients (<21 y old) who underwent discectomy. Procedures were characterized by demographics features, including age of patient, year, and location. Reoperations was defined as discectomy, re-exploration discectomy, fusion, or laminectomy occurring within 5 years of the initial discectomy. A subsequent parallel analysis looked at reoperations following re-exploration discectomies. Kaplan-Meier survival and cox proportional regression analyzed factors impacting survival postprimary discectomy.
Results:
A total of 4410 primary discectomy patients were identified, with an overall 12% reoperation rate within 5 years of the initial discectomy. Specifically, patients under 18 and between the ages of 18 and 21 having a reoperation rate of 7% (115 patients) and 15% (406 patients), respectively. The incidence of discectomy operations increased with patient age. 78% of pediatric cases were performed on an outpatient basis compared with 75% of adult cases. The rate of reoperation was highest within the first year postdiscectomy, with nearly half of reoperations occurring in this time. Specifically, reoperation rates were 2.3% at 3 months, 4% at 6 months, 6% at 1 year, 7% at 2 years, and 12% at 5 years. The most common reoperation procedure was another discectomy. The reoperation rates following these revision operations were 2% at 3 months, 4% at 6 months, 6% at 1 year, 10% at 2 years, and 14% by 5 years. Fusion was the most common procedure following a failed revision discectomy (42% at 5 y). The Kaplan-Meier survival analysis similarly showed most procedures occurred in the first 3 years, with obesity and Elixhauser Comorbidity Index inversely correlated with survival.
Conclusions:
Overall, pediatric reoperation rates following discectomy are 11.8%. Obesity and Elixhauser Comorbidity Index significantly increased risk of reoperation. This study provides real-world, large-scale data that may guide surgeons caring for pediatric patients undergoing microdiscectomy.
Level Of Evidence:
Level III.
