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 patient satisfaction, durability is important when evaluating cost-effectiveness. One and two-level lumbar fusions are some of the most common spinal surgeries. The purpose of this study was to analyze the incidence and indications for reoperation following short-segment lumbar fusion.
Methods: A multi-surgeon, single center database was queried for reoperation following one- or two-level lumbar fusion from 2014 to 2018 with a minimum four year follow-up. Of 5051 patients, 3258 (65%) had a one-level and 1793 (35%) had a two-level fusion, with a mean age of 57.25±13.31 years, BMI of 31.3±6.5kg/m2, ASA of 2.7±0.5, length of stay of 4.1±3.9 days and operative time of 232.3±102.7 minutes.
Results: A total of 772/5051 (15%) patients underwent unplanned reoperation during the study period. The most common indication was adjacent segment disease (288, 6%) occurring at a mean of 1053 days postop, followed by non-union (207, 4%) at a mean of 649 days postop. Non-union was more common in anterior only or posterior only versus circumferential fusions (6-7% versus 3-4%, p=0.003). Other indications for reoperation were infection (109, 2%), implant reposition (34, < 1%), repeat decompression (28, < 1%), hematoma evacuation (16, < 1%), and durotomy repair (2, < 1%). There were no significant differences in reoperation rates between one- and two-level surgeries (85% vs 83%, p=0.073).
Conclusion : One- and two-level lumbar fusions are durable (85%) as currently indicated and performed in a large multi-surgeon spine center. Early reoperation ( < 90 days) for infection, hematoma or revision durotomy repair is rare. Late reoperation (>90 days) for adjacent segment disease and non-union was less in patients who had a circumferential fusion compared to anterior only or posterior only fusion. These data can help guide clinicians and researchers in future quality improvement initiatives.