Revision discectomy is associated with higher rates of subsequent lumbar fusion (SLF) and faster time to SLF that primary discectomy at eight-year follow-up. This is according to research published in The Spine Journal by Sheeraz Qureshi (Hospital for Special Surgery, New York, USA) et al.
The retrospective national-level cohort study sought to determine the eight-year subsequent revision discectomy (SRD)/subsequent lumbar fusion (SLF) rates and time until SRD/SLF after primary/revision discectomy respectively.
The study included patients undergoing primary or revision discectomy, with records in the PearlDiver patient records database from the years 2010–2019. The outcome measures were subsequent surgery type and time to subsequent surgery.
Patients were grouped into primary or revision discectomy cohorts based off of the nature of ‘index’ procedure (primary or revision discectomy) using ICD-9/10 and CPT procedure codes from 2010–19 insurance data sets in the PearlDiver patient records database.
Preoperative demographic data was collected. Outcome measures such as subsequent surgery type and time to subsequent surgery were collected prospectively in the PearlDiver Mariner database. Statistical analysis was performed using BellWeather statistical software. A Kaplan-Meier survival analysis of time to SLF/SRD was performed on each cohort, and log-rank test was used to compare the rates of SLF/SRD between cohorts.
A total of 20,147 patients were identified (17,849 primary discectomy, 2,298 revision discectomy). The eight-year rates of SRD (6.1% in the revision cohort, 4.8% in the primary cohort, p<0.01) and SLF (10.4% in the revision cohort, 6.2% in the primary cohort, p<0.01) were higher after revision vs. primary discectomy.
In addition, time to SLF was shorter after revision discectomy compared with primary discectomy (709 vs. 886 days, p<0.01). After both primary and revision discectomy, the eight-year rate of SLF (10.4% in the revision cohort, 6.2% in the primary cohort, p<0.01) is greater than SRD (6.1% in the revision cohort, 4.8% in the primary cohort, P<0.01).
Speaking to Spinal News International, Qureshi said: “Our study reports eight-year rates of SRD and SLF after primary and revision discectomies. I see two aspects of the clinical significance of these results: One, it is vital information for surgical counselling as patients often inquire about the rates of reoperation, and two, even though the rates are statistically greater after revision discectomy versus primary (6% vs. 5% for SRD and 10% vs. 6% for SLF), these are not major differences looking from the clinical standpoint. This calls for case-based and shared decision-making for additional discectomy versus fusion in cases with symptomatic recurrent disc herniation rather than opting for a fusion in every case.”