Related Experiment Video
Updated: Jun 18, 2026
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Multilevel Oblique Lumbar Interbody Fusion in Degenerative Lumbar Disc Disease with Instability
Published on: July 25, 2025
Durability of One- and Two-Level Lumbar Fusion Surgeries: A Survivorship Analysis Based on Revision Surgery Rates
Surya Dillibabu1, Charles H Crawford, Leah Y Carreon
1From the School of Medicine (Dillibabu), University of Louisville, Louisville, KY, and the Norton Leatherman Spine Center (Dr. Crawford, Dr. Carreon, Dr. Mathew, Dr. Gum, Dr. Djurasovic, Dr. Glassman), Louisville, KY.
Summary
Short-segment lumbar fusion shows high durability, with 15% of patients needing revision surgery. Adjacent segment disease and nonunion are the main reasons for repeat procedures, impacting long-term outcomes.
Area of Science:
- Orthopedic Surgery
- Spine Surgery
- Neurosurgery
Background:
- Durability of surgical treatment is crucial for patients, providers, and payors, influencing clinical outcomes, patient satisfaction, and cost-effectiveness.
- One- and two-level lumbar fusions are common spinal procedures, making their long-term durability a significant concern.
- Understanding revision surgery rates is essential for evaluating the overall success and economic impact of these interventions.
Purpose of the Study:
- To determine the prevalence of revision surgery after short-segment lumbar fusions.
- To identify the timing and primary indications for revision surgery in this patient cohort.
- To assess potential differences in revision rates between one- and two-level lumbar fusions.
Main Methods:
- Retrospective review of a single-institution, multisurgeon database of patients undergoing one- or two-level lumbar fusion between 2014 and 2018.
- Inclusion criteria required a minimum of four years of follow-up, excluding cases of trauma, tumor, or infection.
- Data collected included demographic information, surgical characteristics, and reasons for revision surgery via electronic medical record review.
Main Results:
- Overall, 15% (772 out of 5051) of patients underwent unplanned lumbar revision surgery.
- The most frequent indications for revision were adjacent segment disease (6%) at a mean of 1053 days and nonunion (4%) at a mean of 649 days postoperatively.
- Revision surgery rates were comparable between one-level and two-level lumbar fusions (P = 0.073).
Conclusions:
- One- and two-level lumbar fusion procedures exhibit substantial durability, with a 15% overall rate of revision surgery.
- Adjacent segment disease and nonunion represent the leading causes necessitating revision procedures.
- These findings are valuable for enhancing surgical planning, preoperative patient counseling, and driving quality improvement initiatives in spine surgery.
