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Updated: Apr 17, 2026
Surgical Approach and Complications of Stand-alone Lateral Trans-Psoas Interbody Fusion
Published on: February 14, 2025
Patient-reported outcomes decline after second revision lumbar fusion: a retrospective cohort study
Mitchell Ng1, Joydeep Baidya1, Joshua Mathew1
1Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, 833 Chestnut St., 12th Floor, Philadelphia, PA 19107, USA.
Background Context:
While lumbar fusion revision is associated with inferior outcomes compared to primary surgery, the impact of undergoing multiple revisions remains unclear.
Purpose:
To evaluate surgical and patient-reported outcomes measures (PROMs) after primary, first revision, and second revision lumbar fusion, and to identify characteristics associated with multiple revisions.
Study Design/Setting:
Retrospective cohort study at a single academic center (2011-2022).
Patient Sample:
A total of 747 patients underwent lumbar fusion: 554 had no revision, 153 underwent 1 revision, and 40 underwent ≥2 revisions.
Outcome Measures:
Surgical characteristics and PROMs, including Oswestry Disability Index, visual analog scale for back pain, visual analog scale for leg pain, 12-Item Short Form Survey (SF-12) Physical Component Summary and Mental Component Summary, assessed preoperatively and at 3 months and 1 year postoperatively.
Methods:
Patients were stratified by number of surgeries. Delta PROM scores were calculated. Comparisons were made using analysis of variance (ANOVA) or Kruskal-Wallis tests.
Results:
Patients undergoing revision were more often male (67.9 vs 45.5%, p<.01) and had higher Charlson Comorbidity Index (1.84 vs 0.88, p<.001). Those with ≥2 revisions had more levels fused (3.05 vs 2.26, p=.040) and longer time from index surgery (47.1 vs 31.3 months, p=.002). PROMs declined with each revision. At 1 year, Oswestry Disability Index scores were 23.2 (no revision), 35.4 (1st revision), and 38.1 (2nd revision) (p<.001). Physical Component Summary-12 delta at 3 months was +4.21, -0.60, and -9.49, respectively (p<.001).
Conclusions:
A single revision may yield clinical improvement, but outcomes significantly decline after a second revision. Patients should be counseled on the limited benefit and higher risk of repeated lumbar fusion.
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