title: Reoperation rates following lumbar spine surgery and the influence of spinal fusion procedures.
abstract: METHODS
  Retrospective cohort study using a hospital discharge registry of all nonfederal acute care hospitals in Washington state.
  
  
  OBJECTIVE
  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.
  
  
  BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA, USA. bim@u.washington.edu
authors.forename: Brook I
authors.initials: BI
authors.lastname: Martin
authors.forename: Sohail K
authors.initials: SK
authors.lastname: Mirza
authors.forename: Bryan A
authors.initials: BA
authors.lastname: Comstock
authors.forename: Darryl T
authors.initials: DT
authors.lastname: Gray
authors.forename: William
authors.initials: W
authors.lastname: Kreuter
authors.forename: Richard A
authors.initials: RA
authors.lastname: Deyo
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000639:trends; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000639:trends*