Research Fellow Vanderbilt University Medical Center Vanderbilt University Medical Center
Disclosure(s):
Omar Zakieh, MBBS: No financial relationships to disclose
Introduction: Lumbar laminectomy is a surgical procedure utilized to treat neurogenic claudication, radiculopathy, and other spinal conditions characterized by spinal canal narrowing and compression of the neural elements. Whilst there is ample research on reoperation within the spine surgery literature, the risk factors for reoperation following laminectomy without fusion remains an area in need of further study. In a cohort of patients undergoing lumbar laminectomy, we sought to determine the predictors of time to revision.
Methods: A retrospective cohort study using the Quality Outcome Database was conducted for adult patients who underwent primary laminectomy. Patients undergoing concomitant arthrodesis were excluded. Demographic and clinical variables were collected including age, sex, body mass index (BMI), smoking status, diabetes, osteoporosis, chronic renal disease, prior spine surgery, symptom duration, ASA grade, opioid use preoperatively, ambulation, laminectomy levels, as well as preoperative numerical rating scores (NRS) for neck and arm pain. Cox proportional hazards regression models was constructed for predictors of revision controlling for all baseline variables.
Results: Of 12,584 patients included the mean age was 59.9±15.0, and 59.7% were male. The reoperation rate at 3 months, 12 months and 24 months were 1.8%, 5.6% and 9.0%, respectively. On cox proportional hazard regression, lower age (OR=0.99, 95%CI=0.98-1.00, p=0.006), smoking (OR=1.24, 95%CI=1.01-1.51, p=0.037), prior spine surgery (OR=1.51, 95%CI=1.00-1.41, p=0.047), preoperative opioid use (OR=1,19, 95%CI=1.00-1.41, p=0.047), and preoperative ODI (OR=1.01, 95%CI=1.00-1.01, p=0.005) were independent predictors of reoperation.
Conclusion : In a cohort of patients undergoing primary lumbar laminectomy, smoking, prior spine surgery, and preoperative opioid use were the strongest predictors of reoperation. Preoperative patient counselling is encouraged to promote smoking cessation and discontinuation of opioids prior to primary lumbar laminectomy.