Medical Student Cedars Sinai Medical Center Icahn School of Medicine at Mount Sinai
Introduction: Lumbar discectomy is commonly performed to treat radiculopathy due to disc herniation. Reoperation rates are debated, with reports ranging from 5-24%. This study aims to evaluate reoperation rates following single-level lumbar discectomy, analyze the type of reoperation performed, and identify risk factors for reoperation.
Methods: A retrospective analysis was conducted using the PearlDiver national insurance claims database. Patients aged 18+ who underwent single-level lumbar discectomy with minimum five years follow-up were included. Patients with concurrent procedures and less than five-years follow-up were excluded. The primary outcome was reoperation rate, and secondary analysis evaluated reoperation rates and procedure type following re-exploration discectomy. Kaplan-Meier survival analysis assessed time to reoperation, and Cox models were used to identify factors associated with reoperation.
Results: 308,979 patients were included. 5-year reoperation rate following index discectomy was 14.4%. Of patients who underwent reoperation within 5 years, 42.5% underwent fusion, 33.6% any decompression, and 38.2% re-exploration discectomy. Incidence of reoperation discectomy (n=67,098) over 10 years was about 21.7%. 5-year reoperation rate following revision was 18.2%, and 68% of subsequent surgeries were fusions. Kaplan-Meier curves showed a faster decline in survival probability within the first year following both index discectomy and re-exploration discectomy. Cox regression identified obesity (HR 1.1429) and higher Elixhauser Comorbidity Index (HR 1.0685) as significant predictors of reoperation.
Conclusion : This study found a 14.4% 5-year reoperation rate following lumbar discectomy, and a higher rate (18.2%) after re-exploration. Over a 10-year period, about 21.7% of patients who underwent primary discectomy required reoperation. These findings suggest nearly one-fifth of patients will require reoperation and highlight the need for appropriate patient counseling. Fusion procedures were more common after revision surgery. Further research is needed to determine efficacy of fusion versus non-fusion techniques for recurrent lumbar disc herniation.