Long-Term Reoperation Rates After Single-Level Lumbar Discectomy

Study Design. Retrospective Cohort Study Objective. This study aims to evaluate reoperation rates following single-level lumbar discectomy. Summary of Background Data. Reoperation rates following single-level lumbar discectomy are debated, with reports ranging from 5-24%. Accurately characterizing these rates is essential for provider and patient education. Methods. A retrospective analysis was conducted using the PearlDiver database. Patients aged 18 or older with minimum five years follow-up after a single-level lumbar discectomy were included. The primary outcome was subsequent lumbar surgery rate at five years. Secondary analysis evaluated subsequent lumbar surgery following revision discectomy, lumbar fusion rate after primary or revision discectomy, and risk factors for subsequent lumbar surgery. Kaplan-Meier analysis and Cox regression models were employed. Results. There were 308,979 patients included in this study. The five-year subsequent lumbar surgery rate was 14.4% and the five-year subsequent lumbar fusion rate was 6.1%. There were 67,098 patients who received revision discectomy. Of those, five-year subsequent lumbar surgery rate was 18.2% and subsequent lumbar fusion rate was 12.4%. Kaplan-Meier curves demonstrated that the probability of avoiding subsequent lumbar surgery decreased more rapidly within the first year following both index and revision discectomy. Cox regression identified obesity (HR=1.12, 95% CI=[1.097, 1.141]) and higher Elixhauser Comorbidity Index (HR=1.06, 95% CI=[1.060, 1.068]) as significant predictors of subsequent lumbar surgery following index discectomy. Conclusion. Five-year subsequent lumbar surgery rate following single-level lumbar discectomy was 14.4%, with a higher rate of 18.2% following revision discectomy. This is the largest cohort to date studying reoperation rates after single-level lumbar discectomy. Patients should be counseled regarding the significant risk of subsequent surgeries, particularly after revision discectomy. Fusion procedures were more frequently performed after revision discectomy, underscoring the need to carefully consider surgical planning and patient selection in recurrent lumbar disc herniation cases.