Reoperation Rates Following Lumbar Decompression Surgery at Three or More Levels

In this retrospective study, we sought to investigate the reoperation rates of patients after multilevel (≥ 3) contiguous lumbar decompressions without concomitant fusion.

We reviewed all spine surgeries performed over a 15-year period at a single Veterans Affairs hospital and identified patients who underwent multilevel lumbosacral (L4-S1) decompressions without fusion. Records were reviewed to confirm the surgery performed and determine if any subsequent spinal operations were performed. Patients with follow-up of less than 1 year were excluded.

Forty-five patients (44 M:1 F), with a mean age of 68 years, met minimum 1-year of follow-up (median 27 months) and were included in the final analysis. Three patients (7%) underwent subsequent fusion at a previously decompressed level at 14, 23, and 25 months. Another three (7%) underwent revision decompression at previously decompressed levels at 6, 24, and 130 months. Five patients (11%) underwent reoperation in the first 2 months for wound complications related to infection or hematoma. One patient (2%) underwent debridement of an epidural abscess located three levels cranial to the most proximal decompression 6 years after index surgery; this was determined to be unrelated to the prior decompression. In total, 12 patients (27%) underwent reoperation at time of final follow-up.

The need for subsequent arthrodesis following decompressions of three or more consecutive levels without concomitant fusion may be less than intuitively suspected. Concomitant fusion at the time of index surgery is not necessarily warranted solely based on the number of levels decompressed.