A study recently published in Spine examined the reoperation rate for patients undergoing spine surgery for disc herniation.
Researchers used a national health insurance database to identify patients who underwent first surgery for herniated intervertebral disc disease, and selected 18,590 patients to include in their study. The patients had surgery in 2003 and were followed for five years:
1. 5.4 percent of all patients underwent reoperation after three months.
2. 7.4 percent was the cumulative reoperation rate at one year.
3. 9 percent of all patients had undergone reoperation by the second year after surgery.
4. 12.1 percent was the cumulative reoperation rate at four years.
5. 13.4 percent of the patients underwent reoperation by five years.
6. Reoperation rates after laminectomy were 18.6 percent.
7. Reoperation rates after nucleolysis were 14.7 percent.
8. After open discectomy, 13.8 percent of patients underwent reoperations within five years.
9. Around 12.4 percent of patients who underwent endoscopic discectomy within five years.
10. Reoperation rates for patients who underwent fusion were 11.8 percent.
Reoperation Rate After Surgery for Lumbar Herniated Intervertebral Disc Disease: Nationwide Cohort Study (Spine Magazine)
Study Design. Retrospective cohort study using national health insurance data.
Objective. To provide a longitudinal reoperation rate after surgery for lumbar herniated intervertebral disc (HIVD) disease, and to compare the reoperation rates of surgical methods.
Summary of Background Data. Herniated intervertebral disc disease is the most common cause of lumbar spinal surgery. Despite improved surgical techniques and instrumentation, reoperation cannot be avoided. The reoperation rates were in the range of 6% to 24% in previous studies. A population-based study is less subject to bias; hence, a nationwide longitudinal analysis was warranted.
Methods. A national health insurance database was used to identify a cohort of patients who underwent first surgery for herniated intervertebral disc disease in 2003 and 18,590 patients were selected. Individual patients were followed for at least 5 years through their encrypted unique resident registration number. The primary endpoint was any type of second lumbar surgery. After adjusting for confounding factors, 5 surgical methods (fusion, laminectomy, open discectomy, endoscopic discectomy, and nucleolysis [including mechanical nucleus decompression]) were compared. Open discectomy was used as the reference method.
Results. Open discectomy was the most common procedure (68.9%) followed by endoscopic discectomy (16.1%), laminectomy (7.9%), fusion (3.9%), and nucleolysis (3.2%). The cumulative reoperation rate was 5.4% at 3 months, 7.4% at 1 year, 9% at 2 years, 10.5% at 3 years, 12.1% at 4 years, and 13.4% at 5 years. The reoperation rates were 18.6%, 14.7%, 13.8%, 12.4%, and 11.8% after laminectomy, nucleolysis, open discectomy, endoscopic discectomy, and fusion, respectively. Compared with open discectomy, the reoperation rate was higher after laminectomy at 3 months, whereas the other surgical methods had similar rates.
Conclusion. The cumulative reoperation rate after 5 years was 13.4% and half of the reoperations occurred during the first postoperative year. With the exception of laminectomy, the reoperation rates of the other procedures were not different from that of open discectomy.