Reoperation Rate Lumbar (Fusion, Non-Fusion)Surgery, 11 Yr Results: Spine 2007 Mirza

[Slackwater]

Thanks to Drs. Martin, Mirza, Deyo et al for data that assists my decision process on surgical procedures, Fusion, ADR / TDR / IVD .

MIS (minimally invasive surgery) for the the spine in the nonfusion category ( microsequestrectomy, microdiscectomy ) may/might reduce re-op rates and improve clinical results compared to open surgical procedures circa 1990-1993. Please see note at bottom.



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Reoperations, Eleven (11) Year Results:
20% Fusion (471 reops out of 2345 fusions)
19% Nonfusion (4247 reops out of 22537 nonfusions)

Figure 1.
Long-term cumulative incidence of reoperation. Overall cumulative incidence of reoperation following a lumbar spine surgery performed in 1990 –1993. Patients having initial fusion are separated from those having decompression alone. Data are adjusted for age, gender, comorbidity, and whether or not a patient is covered by workers compensation. reops indicates reoperations.

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PMID: 17268274


Reoperation Rates Following Lumbar Spine Surgery and the Influence of Spinal Fusion Procedures

Brook I. Martin, MPH,*† Sohail K. Mirza, MD, MPH,†‡ Bryan A. Comstock, MS,*† Darryl T. Gray, MD, ScD,†§ William Kreuter, MPA,†§ and Richard A. Deyo, MD, MPH*†‡§

Department of *Medicine, †Center for Cost and Outcomes Research, ‡Department of Orthopaedics and Sports Medicine, and §Department of Health Services, University of Washington; and the Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality, Seattle, WA.


Study Design.
Retrospective cohort study using a hospital discharge registry of all nonfederal acute care hospitals in Washington state.

Objectives
To determine the cumulative incidence of reoperation following lumbar surgery for degenerative disease and, for specific diagnoses, to compare the frequency of reoperation following fusion with that following decompression alone.

Summary of Background Data
Repeat lumbar spine operations are generally undesirable, implying persistent symptoms, progression of degenerative changes, or treatment complications. Compared to decompression alone, spine fusion is commonly viewed as a stabilizing treatment that may reduce the need for additional surgery. However, indications for fusion surgery in degenerative spine disorders remain controversial, and the effects of fusion on reoperation rates are unclear.

Methods
Adults who underwent inpatient lumbar surgery for degenerative spine disorders in 1990–1993 (n = 24,882) were identified from International Classification of Diseases ninth Revision, Clinical Modification codes and then categorized as having either a lumbar decompression surgery or lumbar fusion surgery. We then compared the subsequent incidence of lumbar spine surgery between these groups.

Results
Patients who had surgery in 1990–93 had a 19% cumulative incidence of reoperation during the subsequent 11 years. Patients with spondylolisthesis had a lower cumulative incidence of reoperation after fusion surgery than after decompression alone (17.1% vs. 28.0%, P = 0.002). For other diagnoses combined, the cumulative incidence of reoperation was higher following fusion than following decompression alone (21.5% vs. 18.8%, P = 0.008). After fusion surgery, 62.5% of reoperations were associated with a diagnosis suggesting device complication or pseudarthrosis.

Conclusion
Patients should be informed that the likelihood of reoperation following a lumbar spine operation is substantial. For spondylolisthesis, reoperation is less likely following fusion than following decompression alone. For other degenerative spine conditions, the cumulative incidence of reoperation is higher or unimproved after a fusion procedure compared to decompression alone.

Key words: lumbar, spine, surgery, reoperation, fusion.

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The above article is here, fully printed hard-copy from when I went to the med.school library.


Slackwater
mva: 2-level lumbar surgical candidate



"Less invasive surgeries have become more common and are now the standard of care in various surgical specialties. Much of the impetus for spinal MIS (Minimally Invasive Surgery) is to avoid the paraspinal muscle damage that has been associated with open spinal procedures. Paraspinal muscle damage associated with open spinal surgeries contributes to postoperative pain and may be a source of chronic symptoms. A significant amount of soft tissue dissection and muscle retraction is required to perform spinal fusion and instrumentation. Several studies have documented the harmful effects of extensive dissection and prolonged retraction of soft tissues during lumbar spine fusion." Link, pg 12 of 40, Midwest Orthopaedics, Rush University ( 5 MB download )