title: Quality of life outcomes after revision lumbar discectomy.
abstract: OBJECTIVE
  The authors investigated quality of life (QOL) outcomes after primary versus revision discectomy.
  
  
  METHODS
  A retrospective review was performed for all patients who had undergone a primary or revision discectomy at the Cleveland Clinic Center for Spine Health from January 2008 through December 2011. Among patients in the revision cohort, they identified those who needed a second revision discectomy. Patient QOL measures were recorded before and after surgery. These measures included responses to the EQ-5D health questionnaire, Patient Health Questionnaire-9, Pain and Disability Questionnaire, and quality-adjusted life years (QALYs). Cohorts were compared by using independent-sample t-tests and Fisher exact tests for continuous and categorical variables, respectively. Multivariable logistic regression was performed to adjust for confounding.
  
  
  RESULTS
  A total of 196 patients were identified (116 who underwent primary discectomy and 80 who underwent revision discectomy); average follow-up time was 150 days. There were no preoperative QOL differences between groups. Postoperatively, both groups improved significantly in all QOL measures. For QALYs, the primary cohort improved by 0.25 points (p<0.001) and the revision cohort improved by 0.18 points (p<0.001). QALYs improved for significantly more patients in the primary than in the revision cohort (76% vs 59%, respectively; p=0.02), and improvement exceeded the minimum clinically important difference for more patients in the primary cohort (62% vs 45%, respectively; p=0.03). Of the 80 patients who underwent revision discectomy, yet another recurrent herniation (third herniation) occurred in 14 (17.5%). Of these, 4 patients (28.6%) chose to undergo a second revision discectomy and the other 10 (71.4%) underwent conservative management. For those who underwent a second revision discectomy, QOL worsened according to all questionnaire scores.
  
  
  CONCLUSIONS
  QOL, pain and disability, and psychosocial outcomes improved after primary and revision discectomy, but the improvement diminished after revision discectomy.
authors.affiliation: Cleveland Clinic Lerner College of Medicine.
authors.forename: Daniel
authors.initials: D
authors.lastname: Lubelski
authors.forename: Nilgun
authors.initials: N
authors.lastname: Senol
authors.forename: Michael P
authors.initials: MP
authors.lastname: Silverstein
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Alvin
authors.forename: Edward C
authors.initials: EC
authors.lastname: Benzel
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Mroz
authors.forename: Richard
authors.initials: R
authors.lastname: Schlenk
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D017586:Diskectomy / Q000379:methods; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: MCID = minimum clinically important difference; PDQ = Pain and Disability Questionnaire; PHQ-9 = Patient Health Questionnaire–9; Pain and Disability Questionnaire; Patient Health Questionnaire; QALY; QALY = quality-adjusted life year; QOL = quality of life; lumbar; quality of life; revision discectomy