Attending Surgeon Norton Leatherman Spine Center Princeton University Louisville, KY, US
Disclosure(s):
Charles H. Crawford, MD, III: No relevant disclosure to display
Introduction: Durability of surgical treatment is important to patients, providers, and payors. In addition to the effect on clinical outcomes and satisfaction, durability is important when evaluating cost-effectiveness. Lumbar laminectomy without fusion is a commonly performed procedure. The purpose of this study was to analyze the prevalence and indications for reoperation.
Methods: A multi-surgeon, single-institution database was queried for reoperation following lumbar laminectomy (CPT=63047) without fusion during the study period from 2014 to 2018 with a minimum follow-up of four years (N=609). The mean patient age was 60.54 years, levels decompressed was 1.47, BMI was 31.03kg/m2, ASA was 2.69 (0.57), mean length of stay was 1.02 days, and OR time was 134.42 minutes.
Results: A total of 101/609 patients (17%) underwent unplanned reoperation during the study period. The most common indication for reoperation was instability/recurrent stenosis requiring fusion (N=42, 7%) which occurred at a mean of 615.07 (571.21) days postop. The second most common indication was infection (N=25, 4%) which occurred at a mean of 20.40 (19.4) days postop. Repeat decompression without fusion (N=15, 2%) occurred at a mean of 443.80 (636.32) days postop. Other indications for reoperation were less common ( < 1%) and included: evacuation of hematoma/seroma (N=7) at a mean of 7.86 (5.9) days postop, adjacent segment disease (N=8) at a mean of 998 (651.55) days postop, durotomy repair (N=4) at a mean of 6.00 (2.45) days postop
Conclusion : The current study shows that laminectomy without fusion is a relatively durable procedure (83%) as currently indicated and performed in a large multi-surgeon spine center. Early reoperation ( < 90 days) for infection, hematoma/seroma or durotomy repair is rare. Late reoperation (>90 days) for same segment pathology including recurrent stenosis with or without instability is more common than adjacent segment disease. These data can help guide clinicians and researchers in future quality improvement initiatives.