title: Long-term outcomes after revision neural decompression and fusion for same-level recurrent lumbar stenosis: defining the effectiveness of surgery.
abstract: METHODS
  Single-cohort study of patients undergoing revision neural decompression and fusion for same-level recurrent lumbar stenosis.
  
  
  OBJECTIVE
  To assess the long-term outcomes of revision surgery using validated patient-reported outcomes measures.
  
  
  BACKGROUND
  Recurrent lumbar stenosis may occur after lumbar spine surgery, leading to significant discomfort and radicular pain. Although numerous studies have reported clinical outcomes after primary lumbar surgery, there remains a paucity of data on the outcomes after revision surgery for recurrent same-level stenosis.
  
  
  METHODS
  Fifty-three patients undergoing revision neural decompression and instrumented fusion for same-level recurrent stenosis-associated back and leg pain were included in this study. Baseline and 2-year visual analog scale for leg pain (LP-VAS), visual analog scale for low back pain (BP-VAS), Oswestry Disability Index (ODI), Zung self-reported depression score (ZDS), time to narcotic independence, time to return to work, health-state utility [EuroQol (EQ-5D)], and physical and mental quality of life [SF-12 physical and mental component scores (PCS and MCS)] were assessed.
  
  
  RESULTS
  Mean±SD duration of time between index surgery and revision surgery was 4.00±4.19 years. A significant improvement from baseline was observed in BP-VAS (9.28±1.01 vs. 5.00±2.94, P=0.001), LP-VAS (9.55±0.93 vs. 3.45±2.95, P=0.001), and ODI (36.02±6.01 vs. 21.75±12.08, P=0.001). Mean±SD SF-12 PCS (7.17±11.22, P=0.001), SF-12 MCS (12.57±13.03, P=0.001), ZDS (12.37±16.80, P=0.001), and EQ-5D (0.42±0.34, P=0.001) were also significantly improved. The mean cumulative 2-year gain in health-utility state was 0.84 QALY. Median (interquartile range) duration of postoperative narcotic use was 6 (1.4-12.2) months and time of missed work was 6 (4.0-10.0) months.
  
  
  CONCLUSIONS
  Our study suggests that revision neural decompression and instrumented fusion for recurrent same-level stenosis provides significant improvement in all patient-assessed outcome metrics and should be offered as a viable treatment option.
authors.affiliation: Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Stephen K
authors.initials: SK
authors.lastname: Mendenhall
authors.forename: Scott L
authors.initials: SL
authors.lastname: Parker
authors.forename: Owoicho
authors.initials: O
authors.lastname: Adogwa
authors.forename: David N
authors.initials: DN
authors.lastname: Shau
authors.forename: Joseph
authors.initials: J
authors.lastname: Cheng
authors.forename: Oran
authors.initials: O
authors.lastname: Aaronson
authors.forename: Clinton J
authors.initials: CJ
authors.lastname: Devin
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: McGirt
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003251:Constriction, Pathologic; D019299:Decompression, Surgical / Q000379:methods*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D017116:Low Back Pain / Q000601:surgery; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D010147:Pain Measurement; D011788:Quality of Life; D012008:Recurrence; D012086:Reoperation / Q000379:methods*; D062707:Return to Work; D013123:Spinal Fusion / Q000379:methods*; D013130:Spinal Stenosis / Q000601:surgery*; D016896:Treatment Outcome