Risk Factors for Reoperation in Patients Treated Surgically for Intervertebral Disc Herniation: A Subanalysis of Eight-Year SPORT Data.
BACKGROUND
Lumbar discectomy and laminectomy in patients with intervertebral disc herniation (IDH) is common, with variable reported reoperation rates. Our study examined which baseline characteristics might be risk factors for reoperation and compared outcomes between patients who underwent reoperation and those who did not.


METHODS
We performed a retrospective subgroup analysis of patients from the IDH arm of the Spine Patient Outcomes Research Trial (SPORT) randomized and observational cohorts. We analyzed baseline characteristics and outcomes of patients who underwent reoperation and those who did not with use of data collected from enrollment through eight-years of follow-up after surgery. Follow-up times were measured from the time of surgery, and baseline covariates were updated to the follow-up immediately preceding the time of surgery for outcomes analyses.


RESULTS
At eight years, the reoperation rate was 15% (691 no reoperation; 119 reoperation). Sixty-two percent of these patients underwent reoperation because of a recurrent disc herniation; 25%, because of a complication or other factor; and 11%, because of a new condition. The proportion of reoperations that were performed for a recurrent disc herniation ranged from 58% to 62% in the individual years. Older patients were less likely to have reoperation (p = 0.015), as were patients presenting with asymmetric motor weakness at baseline (p = 0.0003). Smoking, diabetes, obesity, Workers' Compensation, and clinical depression were not associated with a greater risk of reoperation. Scores on the Short Form (SF)-36 for bodily pain and physical functioning, the Oswestry Disability Index (ODI), and the Sciatica Bothersomeness Index as well as satisfaction with symptoms had improved less at the time of follow-up in the reoperation group (p < 0.001).


CONCLUSIONS
In patients who underwent surgery for IDH, the overall reoperation rate was 15% at the eight-year follow-up. Patients of older age and patients presenting with asymmetric motor weakness were less likely to undergo a reoperation. Less improvement in patient-reported outcomes was noted in the reoperation group.
Department of Orthopaedic Surgery, New York University Langone Medical Center, 301 East 17th Street, New York, NY 10003. E-mail address for D. Leven: danteleven@hotmail.com.
Dante
D
Leven
Department of Orthopaedic Surgery, New York University Langone Medical Center, 301 East 17th Street, New York, NY 10003. E-mail address for D. Leven: danteleven@hotmail.com.
Peter G
PG
Passias
Department of Orthopaedic Surgery, New York University Langone Medical Center, 301 East 17th Street, New York, NY 10003. E-mail address for D. Leven: danteleven@hotmail.com.
Thomas J
TJ
Errico
Department of Orthopaedic Surgery, New York University Langone Medical Center, 301 East 17th Street, New York, NY 10003. E-mail address for D. Leven: danteleven@hotmail.com.
Virginie
V
Lafage
Department of Orthopaedic Surgery, New York University Langone Medical Center, 301 East 17th Street, New York, NY 10003. E-mail address for D. Leven: danteleven@hotmail.com.
Kristina
K
Bianco
Department of Orthopaedic Surgery, New York University Langone Medical Center, 301 East 17th Street, New York, NY 10003. E-mail address for D. Leven: danteleven@hotmail.com.
Alexandra
A
Lee
Geisel School of Medicine at Dartmouth, Dartmouth College, 1 Rope Ferry Road, Hanover, NH 03755.
Jon D
JD
Lurie
Geisel School of Medicine at Dartmouth, Dartmouth College, 1 Rope Ferry Road, Hanover, NH 03755.
Tor D
TD
Tosteson
Geisel School of Medicine at Dartmouth, Dartmouth College, 1 Rope Ferry Road, Hanover, NH 03755.
Wenyan
W
Zhao
Geisel School of Medicine at Dartmouth, Dartmouth College, 1 Rope Ferry Road, Hanover, NH 03755.
Kevin F
KF
Spratt
Geisel School of Medicine at Dartmouth, Dartmouth College, 1 Rope Ferry Road, Hanover, NH 03755.
Tamara S
TS
Morgan
Department of Orthopaedic Surgery, New York University Langone Medical Center, 301 East 17th Street, New York, NY 10003. E-mail address for D. Leven: danteleven@hotmail.com.
Michael C
MC
Gerling
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000367:Age Factors; D017586:Diskectomy / Q000009:adverse effects / Q000379:methods; D005500:Follow-Up Studies; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging / Q000601:surgery; D008159:Lumbar Vertebrae; D010147:Pain Measurement; D011788:Quality of Life; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D012008:Recurrence; D012086:Reoperation / Q000379:methods; D018570:Risk Assessment; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D016032:Randomized Controlled Trials as Topic; D064887:Observational Studies as Topic