Smoking and a higher preoperative disability are both independent risk factors for same-site recurrent disc herniation (sRDH), according to a new study which was published in The Bone and Joint Journal by Jonathan Geere (Spire Norwich Hospital, Norwich, UK) et al.
According to the study authors, these findings—which also indicate that being a smoker is an independent risk factor for sRDH reoperation—can help assist spinal surgeons and rehabilitation specialists in risk assessment, consenting patients, and perioperative management.
The study aimed to identify the incidence and risk factors for five-year sRDH after primary single-level lumbar discectomy. The secondary outcome was the incidence and risk factors for five-year sRDH reoperation.
A retrospective study was conducted using prospectively collected data and patient-reported outcome measures, including the Oswestry Disability Index (ODI), between 2008 and 2019. Postoperative sRDH was identified from clinical notes and the centre’s magnetic resonance imaging (MRI) database, with all imaging providers in the region checked for missing events. The Kaplan-Meier method was used to calculate five-year sRDH incidence. Cox proportional hazards model was used to identify independent variables predictive of sRDH, with any variable not significant at the p< 0.1 level removed. Hazard ratios (HRs) were calculated with 95% confidence intervals (CIs).
Complete baseline data capture was available for 733 of 754 (97.2%) consecutive patients. Median follow-up time for censored patients was 2.2 years (interquartile range [IQR] 1 to 5). sRDH occurred in 63 patients at a median 0.8 years (IQR 0.5 to 1.7) after surgery.
The five-year Kaplan-Meier estimate for sRDH was 12.1% (95% CI 9.5 to 15.4), sRDH reoperation was 7.5% (95% CI 5.5 to 10.2), and any-procedure reoperation was 14.1% (95% CI 11.1 to 17.5). Current smoker (HR 2.12 (95% CI 1.26 to 3.56)) and higher preoperative ODI (HR 1.02 (95% CI 1 to 1.03)) were independent risk factors associated with sRDH. Current smoker (HR 2.15 (95% CI 1.12 to 4.09)) was an independent risk factor for sRDH reoperation.
Speaking to Spinal News International, Geere said: “Within the private sector we have prospectively collected data since 2008 to determine the outcomes after our intervention. Data collection provides a record for the patient, and evidence for surgeons if questions are asked about treatment. We have one of the largest databases from a single-centre in Europe to enable us to better understand how to best care for our patients. We are in process