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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.
Introduction:
Durability of surgical treatment is important to patients, providers, and payers. Lumbar diskectomy is one of the most commonly performed spinal surgeries. Understanding the specific indications for revision surgery can help guide future research and quality improvement initiatives.
Methods:
A multisurgeon, single-institution database was queried for revision surgery following a primary lumbar diskectomy (CPT = 63,030) from 2014 to 2018 with a minimum follow-up of 4 years (N = 1,133). The mean patient age was 44.93 years, levels decompressed was 1.08, mean body mass index was 30.45 kg·m -2 , mean American Society of Anesthesiologists (ASA) score was 2.33, length of stay was 0.44 days, and mean OR time was 115.41 minutes. Primary indication for revision surgery was collected through medical record analysis.
Results:
A total of 185 of 1,133 patients (16%) underwent unplanned revision surgery during the study period. The most common indication for revision surgery was repeat decompression (N = 80, 7%) at a mean of 334.2 days postoperatively. The second most common indication was instability requiring fusion (N = 53, 5%) at a mean of 640.89 days postoperatively. Surgery for infection (N = 22, 1.9%) occurred at a mean of 37.77 days postoperatively. Other indications for revision surgery were less common and included: adjacent segment disease (N = 13, 1.1%) at a mean of 682.31 days postoperatively, durotomy repair (N = 13, 1.1%) at a mean of 26.77 days postoperatively, evacuation of hematoma/seroma (N = 4, 0.3%) at a mean of 6.75 days postoperatively. Binary logistic regression showed that age ( P = 0.368), number of surgical levels ( P = 0.694), and ASA grade ( P = 0.152) were not associated with revision surgery. The only factor associated with revision surgery was BMI ( P = 0.005; odds ratio: 1.042; 95% CI, 1.01-1.07).
Discussion:
The results of this study show that lumbar diskectomy is a relatively durable procedure (84%) as currently indicated and performed in a large multisurgeon spine center. Early revision surgery (<90 days) for infection, hematoma/seroma, or durotomy repair is rare (3.3%). Late revision surgery (>90 days) for same segment pathology including recurrent stenosis with or without instability (12%) is much more common than adjacent segment disease (1.1%). These data can help guide clinicians and researchers in future quality improvement initiatives.
