Spinal reoperation

• Efficacy of repeat discectomy alone versus with spinal fusion in recurrent lumbar disc herniation: a systematic review and meta-analysis of randomized studies
• Posterior spinal fusion outcomes for moderate adolescent idiopathic scoliosis in boys and girls: should we counsel them the same?
• Minimally invasive decompression versus open laminectomy in multilevel lumbar stenosis: A systematic review and meta-analysis
• Outcomes of Primary vs. Revision TLIF Following Decompression Alone in Degenerative Spondylolisthesis: A Retrospective Propensity Score Matched Study
• A retrospective analysis of patients deemed ineligible for surgery in a multidisciplinary complex spine conference
• Separation surgery with cement-augmented short-segment fixation for spinal metastasis: early experience with carbon fiber-reinforced polyetheretherketone instrumentation
• Risk Factors for Lumbar Spinal Fusion Reoperation: An Unusual Suspect: Commentary on an article by Emily S. Mills, MD, et al.: "Patients with Hip Osteoarthritis Have a Higher Rate of Spinal Reoperation Following Lumbar Spinal Fusion"
• Evaluation of short- and mid-term benefits of re-operative surgery in iatrogenic spondylolisthesis cases

Beyond initial lesions, any form of spinal (re)operation can cause direct potential aggression to the nervous system by contact with neural tissue or by imprinting a morphological change on the neural tissue. The potential consequences of nerve root injury affect both peripheral and axial dermatomal distribution. The hypothesis of a possible neuropathic aspect associated with the back pain component of failed back surgery syndrome (FBSS) therefore appears to be reasonable. Its pathophysiology remains unclear due to the permanent interplay between nociceptive and neuropathic pain components, resulting in the coexistence of physiological and pathological pain at the same anatomical site.

Smoking was the strongest predictor of reoperation in patients who had undergone single-level laminectomy, multilevel laminectomy, or reoperation for progression of spinal degeneration. These findings suggest that tobacco smokings have worse outcomes of lumbar decompression than nonsmokers ¹⁾.

Lumbar disc herniation (LDH) is a common spinal problem with reoperation rates of 6-24%. Although different surgical techniques are used for treatment, there is still debate regarding whether fusion techniques can reduce the reoperation rate in LDH patients.

This retrospective study used a 5-year nationwide database to analyze reoperation rates in Taiwan. Patient age groups (≥20 and <90) treated by index surgery and reoperation for LDH were identified. Four surgical procedures were included in the analysis: discectomy (DC), anterior lumbar fusion with DC (FA+DC); posterior lumbar fusion (FP); and posterior lumbar fusion with DC (FP+DC).

There were 1743 index surgeries between 2008 and 2012, with 184 (10.56%) reoperations. Index surgery DC had the highest reoperation rate (n = 121, 20%). The reoperation risk was significantly lower for patients undergoing fusion procedures [FA+DC vs. DC (HR: 0.24, 95% CI: 0.12-0.47, p<0.01), FP vs. DC (HR: 0.17, 95% CI: 0.09-0.33, p<0.01), FP+DC vs. DC (HR: 0.31, 95% CI: 0.22-0.44, p<0.01)]. Fusion procedures had significantly higher treatment costs compared to DC (FA+DC vs. FP vs. FP+DC vs. DC: 5,851,74 ± 4,808.94 vs. 5,116.88 ± 3,428.97 vs. 4,782.16 ± 2,902.19 vs. 3,846.79 ± 3,584.45 US dollars/patient, respectively, p<0.0001).

Among surgical procedures for LDH, fusion techniques are related to lower reoperation rates compared to discectomy, but at the expense of higher medical costs ²⁾.

Cervical Spinal Reoperation