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Durability of Lumbar Diskectomy: A Survivorship Analysis Based on Revision Surgery Rates
Charles H Crawford1, Wyatt Ware, Justin Mathew
1From the Norton Leatherman Spine Center, Louisville, KY (Crawford, Mathew, Gum, Owens, Djurasovic, Glassman, and Carreon), the Department of Orthopaedic Surgery, University of Louisville School of Medicine, Louisville, KY (Crawford, Mathew, Gum, Owens, Djurasovic, and Glassman), and the University of Louisville School of Medicine (Ware), Louisville, KY.
Lumbar diskectomy is a durable procedure, with 84% of patients not requiring revision surgery. Revision is most often due to repeat decompression or instability, with higher BMI being a risk factor.
Area of Science:
- Spine Surgery
- Neurosurgery
- Orthopedic Surgery
Background:
- Surgical treatment durability is crucial for patients, providers, and payers.
- Lumbar diskectomy is a frequent spinal surgical procedure.
- Identifying indications for revision surgery can improve quality initiatives.
Purpose of the Study:
- To analyze the indications and outcomes of revision surgery after lumbar diskectomy.
- To identify factors associated with the need for revision surgery.
- To inform future research and quality improvement in spinal surgery.
Main Methods:
- A retrospective analysis of a single-institution database (2014-2018) including 1,133 patients who underwent lumbar diskectomy.
- Minimum follow-up of 4 years was required.
- Indications for revision surgery were determined through medical record review.
Main Results:
- 16% of patients (185/1,133) required unplanned revision surgery.
- Most common indications: repeat decompression (7%) and instability requiring fusion (5%).
- Higher Body Mass Index (BMI) was significantly associated with revision surgery (P=0.005).
Conclusions:
- Lumbar diskectomy demonstrates good durability, with 84% of patients not needing revision.
- Early revisions (<90 days) for complications like infection or durotomy are rare (3.3%).
- Late revisions (>90 days) are more commonly due to recurrent stenosis or instability (12%) than adjacent segment disease (1.1%).
