Comparison of Reoperation after Fusion and after Decompression for Degenerative Lumbar Spinal Stenosis: A Single-Center Experience of 987 Cases

Abstract

Background and Study Aim Reoperation for lumbar spinal stenosis (LSS) is technically challenging. Studies comparing preoperative risk factors and reoperation outcomes between spinal fusion and spinal decompression are limited. Thus this study compared fusion and decompression with respect to reoperation rates, preoperative factors related to re-surgery, and clinical outcomes. Patients and Methods This retrospective cohort study included prospectively collected data from patients who underwent revision surgeries for degenerative LSS between May 2001 and March 2015. The reoperation rate, risk factors (proportional hazards analysis of index surgery), surgery type, main reason for revision, and final clinical outcomes (pain, quality-of-life modification, patient satisfaction, and complication rate) were analyzed and compared between the fusion and decompression surgeries. Results Among 987 cases during 13 years, 25 cases of reoperation after fusion and 23 cases of reoperation after decompression were identified, accounting for reoperation rates of 5.88% and 4.00%, respectively. Combined comorbidities (hazard ratio [HR]: 1.98 for fusion; multilevel involvement [with fusion, HR: 2.92; decompression, HR: 1.95]) were strongly correlated with preoperative demographic risk factor for each procedure. The main reason for reoperation in fusion cases was proximal junctional kyphosis (40%) and implant failure (20%), and in decompression cases, recurrent lesions (48.8%) and incomplete surgery (17.4%) An additional fusion after initial fusion and re-decompression without fusion after initial decompression were the most common surgical procedure. Back pain and patient satisfaction after fusion were better compared with those after decompression. Conclusion The reoperation rate, preoperative risk factors, reason for revision, reoperation type, clinical outcomes, patient satisfaction, and time interval between index and re-surgery were different between the primary fusion and primary decompression. A better understanding of disease pathophysiology and surgical procedure characteristics will facilitate improvement in disease management and the development of treatment strategies.

Revision Spinal Surgery at a University Hospital: Incidence, Causes, and Microbiological Agents in Infected Patients

“…by guest on September 18, 2022 http://ijssurgery.com/ Downloaded from a reoperation rate of 9.7%, while other studies have reported rates between 4% and 14.9%. [13][14][15] The reoperation rate for open discectomy in our cohort was 6.6%, corresponding to 5.6% to 9.8% in previous studies. 16,17 The most common cause of reoperation in our study population was infection, representing 28% of all reoperations.…”

Reoperations After Percutaneous Endoscopic Transforaminal Decompression for Treating Lumbar Spinal Stenosis: Incidence and Predictors

“… 13 , 14 Blumenthal et al reviewed patients with symptomatic stenosis with grade I degenerative lumbar spondylolisthesis and found that incidence of reoperation was as high as 37.5% at a mean follow-up duration of 3.6 years. 9 The main deficit of open laminectomy is wide disruption of posterior supporting structures for segmental instability, while decompression combined with spinal fusion may cause complications such as proximal junctional kyphosis and pseudarthrosis, 29 which are all responsible for the such high incidence of reoperation. A systematic review and meta-analysis showed that fusion increased the risk of reoperation relative to decompression alone when treating LSS without spondylolisthesis.…”

Unilateral Biportal Endoscopic Discectomy versus Microendoscopic Discectomy for the Treatment of Lumbar Spinal Stenosis: A Systematic Review and Meta-Analysis

“…The continuous flushing function is conducive to controlling bleeding and providing a clearer surgical field of vision. UBED does not need a sleeve and will not restrict the use of instruments [ 43 ]. Conventional arthroscopic instruments and spinal open surgery instruments can be used, which can save costs [ 44 ].…”