Reoperation rate after surgery for lumbar spinal stenosis without spondylolisthesis: A nationwide cohort study
Lumbar spinal stenosis is one of the most common degenerative spine diseases. Surgical options are largely divided into decompression only and decompression with arthrodesis. Recent randomized trials showed that surgery was more effective than nonoperative treatment for carefully selected patients with lumbar stenosis. However, some patients require reoperation because of complications, failure of bony fusion, persistent pain, or progressive degenerative changes, such as adjacent segment disease. In a previous population-based study, the 10-year reoperation rate was 17%, and fusion surgery was performed in 10% of patients. Recently, the lumbar fusion surgery rate has doubled, and a substantial portion of the reoperations are associated with a fusion procedure. With the change in surgical trends, the longitudinal surgical outcomes of these trends need to be reevaluated.
To provide the longitudinal reoperation rate after surgery for spinal stenosis and to compare the reoperation rates between decompression and fusion surgeries.
Retrospective cohort study using national health insurance data.
A cohort of patients who underwent initial surgery for lumbar stenosis without spondylolisthesis in 2003.
The primary end point was any type of second lumbar surgery. Cox proportional hazards regression modeling was used to compare the adjusted reoperation rates between decompression and fusion surgeries.
A national health insurance database was used to identify a cohort of patients who underwent an initial surgery for lumbar stenosis without spondylolisthesis in 2003; a total of 11,027 patients were selected. Individual patients were followed for at least 5 years through their encrypted unique resident registration number. After adjusting for confounding factors, the reoperation rates for decompression and fusion surgery were compared.
Fusion surgery was performed in 20% of patients. The cumulative reoperation rate was 4.7% at 3 months, 7.2% at 1 year, 9.4% at 2 years, 11.2% at 3 years, 12.5% at 4 years, and 14.2% at 5 years. The adjusted reoperation rate was not different between decompression and fusion surgeries (p=.82). The calculated reoperation rate was expected to be 22.9% at 10 years.
The reoperation rate was not different between decompression and fusion surgeries. With current surgical trends, the reoperation rate appeared to be higher than in the past, and consideration of this problem is required.
Available from: Chi Heon Kim
- "Although a statistically significant difference was not obtained after fusion surgery during the 5-year follow-up period, the reoperation rate might be higher in diabetic patients than in nondiabetic patients after fusion surgery with longer follow-up (Fig. 2). Diabetes might continuously influence reoperation rates through direct or indirect association with the aforementioned problems        . "
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ABSTRACT: Diabetes is present in 5 - 20 % of patients undergoing spine surgeries and is a known risk factor for reoperation. Considering the chronicity of diabetes, its influence on the reoperation rate may differ over time.
To present the relationship between diabetes and the reoperation rate over time.
Retrospective cohort study PATIENT SAMPLE: A national health insurance database was used to identify a cohort of patients who underwent an initial surgery for lumbar degenerative disease in 2003 (n = 34,918).
The primary end-point was any type of second lumbar surgery after fusion surgery (n = 4,792) or decompression surgery (n = 30,126) during the early (0 - postoperative 90 days), short-term (91 - 365 days) and mid-term (1 - 6 years) periods.
All patients were followed-up until Dec. 2008. Cox proportional hazards regression modeling was used to assess the adjusted reoperation rates in the diabetic patients.
The incidence of diabetes in the present cohort was 24.5 % in the fusion group and 16.9 % in the decompression group. Overall, reoperation was performed in 13.2 % (631/4,792) of the patients after fusion surgery and in 14.0 % (4,214/30,126) of the patients after decompression surgery. After fusion surgery, diabetes did not make a significant difference in the reoperation rate during the entire follow-up period. After decompression surgery, the reoperation rate was not different during postoperative month 3, but diabetic patients showed a 1.2 - 1.4-times higher reoperation rate during postoperative 3 months to 5 years (p < 0.01).
The study did not find a relationship between diabetes at the time of surgery and the reoperation rate during the early postoperative period. Thereafter, the reoperation rate was not higher after fusion surgery in diabetic patients, but it was higher after decompression surgery.
Copyright © 2015 Elsevier Inc. All rights reserved.
The spine journal: official journal of the North American Spine Society 01/2015; 15(5). DOI:10.1016/j.spinee.2015.01.029 · 2.43 Impact Factor
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Symptomatic adjacent-segment lumbar disease (ASLD) after lumbar fusion often requires subsequent surgical intervention. The authors report utilizing cortical bone trajectory (CBT) pedicle screw fixation with intraoperative CT (O-arm) image-guided navigation to stabilize spinal levels in patients with symptomatic ASLD. This unique technique results in the placement of 2 screws in the same pedicle (1 traditional pedicle trajectory and 1 CBT) and obviates the need to remove preexisting instrumentation.
The records of 5 consecutive patients who underwent lumbar spinal fusion with CBT and posterior interbody grafting for ASLD were retrospectively reviewed. All patients underwent screw trajectory planning with the O-arm in conjunction with the StealthStation navigation system. Basic demographics, operative details, and radiographic and clinical outcomes were obtained.
The average patient age was 69.4 years (range 58-82 years). Four of the 5 surgeries were performed with the Minimal Access Spinal Technologies (MAST) Midline Lumbar Fusion (MIDLF) system. The average operative duration was 218 minutes (range 175-315 minutes). In the entire cohort, 5.5-mm cortical screws were placed in previously instrumented pedicles. The average hospital stay was 2.8 days (range 2-3 days) and there were no surgical complications. All patients had more than 6 months of radiographic and clinical follow-up (range 10-15 months). At last follow-up, all patients reported improved symptoms from their preoperative state. Radiographic follow-up showed Lenke fusion grades of A or B.
The authors present a novel fusion technique that uses CBT pedicle screw fixation in a previously instrumented pedicle with intraoperative O-arm guided navigation. This method obviates the need for hardware removal. This cohort of patients experienced good clinical results. Computed tomography navigation was critical for accurate CBT screw placement at levels where previous traditional pedicle screws were already placed for symptomatic ASLD.
Neurosurgical FOCUS 03/2014; 36(3):E9. DOI:10.3171/2014.1.FOCUS13521 · 2.11 Impact Factor
Available from: Toshimi Aizawa
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ABSTRACT: Purpose Fenestration is the gold standard surgery for lumbar spinal canal stenosis in Japan. Several previous studies have analyzed the reoperation rates in large numbers of patients undergoing several surgical procedures such as laminectomy with or without instrumented spinal fusion; however, there have been few studies focusing solely on fenestration. The purpose of this study was to calculate the reoperation rates after fenestration using the survival function method. Methods Form 1988-2007, 6,998 surgeries for lumbar spinal canal stenosis occurred in Miyagi prefecture, Japan, and these patients were enrolled by the spinal surgery registration system of the Department of Orthopaedic Surgery, Tohoku University. Among these, 5,835 surgeries involved fenestration as a primary surgery and for those who underwent ≥2 lumbar surgeries we analyzed the reoperation rates using the Kaplan-Meier method. Results Among the 5,835 patients undergoing primary fenestration, 215 patients underwent 221 revisions; 112 included the same spinal levels and 103 were revised only at other levels as primary fenestration. The overall reoperation rates were 0.8 % at 1 year, 2.9 % at 5 years, 5.2 % at 10 years, 7.5 % at 15 years and 8.6 % at >17.7 years. Reoperation rates for those at the same spinal levels were 0.6 % at 1 year, 1.7 % at 5 years, 2.7 % at 10 years, 3.8 % at 15 years, and 4.1 % at >17.0 years. Conclusions Fenestration can be performed at low cost using standard spinal surgery equipments. The reoperation rates of this procedure were lower than previously reported for several other surgical procedures.
European Spine Journal 07/2014; DOI:10.1007/s00586-014-3479-4 · 2.07 Impact Factor
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