Durability of One- and Two-Level Lumbar Fusion Surgeries: A Survivorship Analysis Based on Revision Surgery Rates

Durability of surgical treatment is important to patients, providers, and payors. In addition to its effect on clinical outcomes and patient satisfaction, durability is a critical factor in evaluating the cost-effectiveness of care. One- and two-level lumbar fusion surgeries are among the most common spine procedures. The purpose of this study was to determine the prevalence, timing, and indications for revision surgery following short-segment lumbar fusions.

A single-institution, multisurgeon database was retrospectively reviewed for patients who underwent one- or two-level lumbar fusion between 2014 and 2018, with a minimum of four years of follow-up. Patients with surgery for trauma, tumor, or infection were excluded. Of the 5051 consecutive patients included, 64.5% (n = 3258) underwent one-level and 35.5% (n = 1793) underwent two-level fusion. Demographic data, surgical characteristics, and indications for revision surgery were collected through electronic medical record review.

A total of 772 patients (15%) underwent unplanned lumbar revision surgery. The most common indications were adjacent segment disease (n = 288, 6%) at a mean of 1053 days postoperatively and nonunion (n = 207, 4%) at a mean of 649 days. Other causes of revision surgery included infection (2%), implant reposition (<1%), repeat decompression (<1%), hematoma evacuation (<1%), and revision durotomy repair (<1%). Revision surgery rates were similar between one- and two-level fusions (P = 0.073).

One- and two-level lumbar fusion procedures demonstrated high durability with an overall revision surgery rate of 15%. The most common indications for revision surgery are adjacent segment disease and nonunion. These findings may inform surgical planning, guide preoperative counseling, and support future quality-improvement efforts.