Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA.
University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR 72205, USA.
Spine J. 2022 Dec;22(12):1983-1989. doi: 10.1016/j.spinee.2022.06.005. Epub 2022 Jun 18.
Published rates for disc reherniation following primary discectomy are around 6%, but the ultimate reoperation outcomes in patients after receiving revision discectomy are not well understood. Additionally, any disparity in the outcomes of subsequent revision discectomy (SRD) versus subsequent lumbar fusion (SLF) following primary/revision discectomy remains poorly studied.
To determine the 8-year SRD/SLF rates and time until SRD/SLF after primary/revision discectomy respectively.
Retrospective cohort study.
Patients undergoing primary or revision discectomy, with records in the PearlDiver Patient Records Database from the years 2010 to 2019.
Subsequent surgery type and time to subsequent surgery.
Patients were grouped into primary or revision discectomy cohorts based off of the nature of "index" procedure (primary or revision discectomy) using ICD9/10 and CPT procedure codes from 2010 to 19 insurance data sets in the PearlDiver Patient Records Database. Preoperative demographic data was collected. Outcome measures such as subsequent surgery type (fusion or discectomy) and time to subsequent surgery were collected prospectively in PearlDiver Mariner database. Statistical analysis was performed using BellWeather statistical software. A Kaplan-Meier survival analysis of time to SLF/SRD was performed on each cohort, and log-rank test was used to compare the rates of SLF/SRD between cohorts.
A total of 20,147 patients were identified (17,849 primary discectomy, 2,298 revision discectomy). The 8-year rates of SRD (6.1% in revision cohort, 4.8% in primary cohort, p<.01) and SLF (10.4% in revision cohort, 6.2% in primary cohort, p<.01) were higher after revision versus primary discectomy. Time to SLF was shorter after revision versus primary discectomy (709 vs. 886 days, p<.01). After both primary and revision discectomy, the 8-year rate of SLF (10.4% in revision cohort, 6.2% in primary cohort, p<.01) is greater than SRD (6.1% in revision cohort, 4.8% in primary cohort, p<.01).
Compared to primary discectomy, revision discectomy has higher rates of SLF (10.4% vs. 6.2%), and faster time to SLF (2.4 vs. 1.9 years) at 8-year follow up.
初次椎间盘切除术后椎间盘再突出的报告发生率约为 6%，但接受翻修椎间盘切除术的患者的最终再手术结果尚不清楚。此外，初次/翻修椎间盘切除术后行翻修椎间盘切除术（SRD）与腰椎融合术（SLF）的结果差异仍研究甚少。
确定初次/翻修椎间盘切除术后 8 年的 SRD/SLF 发生率和再次手术的时间。
回顾性队列研究。
2010 年至 2019 年，PearlDiver 患者记录数据库中接受初次或翻修椎间盘切除术的患者记录。
后续手术类型和再次手术时间。
根据“索引”手术（初次或翻修椎间盘切除术）的性质，使用 2010 年至 19 项保险数据集的 ICD9/10 和 CPT 手术代码，将患者分为初次或翻修椎间盘切除术组。收集术前人口统计学数据。使用 PearlDiver Mariner 数据库前瞻性收集后续手术类型（融合或椎间盘切除术）和再次手术时间等结果指标。使用 BellWeather 统计软件进行统计分析。对每个队列进行 SLF/SRD 时间的 Kaplan-Meier 生存分析，并使用对数秩检验比较队列间 SLF/SRD 的发生率。
共确定了 20147 名患者（初次椎间盘切除术 17849 例，翻修椎间盘切除术 2298 例）。翻修组 8 年 SRD 发生率（6.1%）和 SLF 发生率（10.4%）高于初次椎间盘切除术组（4.8%和 6.2%，均<.01）。翻修组的 SLF 时间短于初次椎间盘切除术组（709 天 vs. 886 天，<.01）。初次和翻修椎间盘切除术后，8 年 SLF 发生率（翻修组 10.4%，初次组 6.2%，均<.01）大于 SRD（翻修组 6.1%，初次组 4.8%，均<.01）。
与初次椎间盘切除术相比，翻修椎间盘切除术的 SLF 发生率更高（10.4%比 6.2%），8 年随访时 SLF 时间更快（2.4 年比 1.9 年）。
