title: Reoperation Rates After Single-level Lumbar Discectomy.
abstract: METHODS
  Retrospective analysis of national insurance billing database.
  
  
  OBJECTIVE
  To examine trends in reoperation after single-level lumbar discectomy.
  
  
  BACKGROUND
  Lumbar discectomy is the most commonly performed procedure for treatment of radiculopathy caused by disc herniation. Randomized clinical trials have demonstrated the advantage of discectomy over nonsurgical treatment options, allowing for a more rapid reduction in symptoms. However, population-level data regarding reoperation after single level discectomy is limited.
  
  
  METHODS
  Data were collected using the commercially available PearlDiver software for patients billed with the Current Procedural Terminology code for our index procedure, hemilaminotomy and removal of disc material, between January 2007 and September 2014. The index group was then followed for up to 4 years for recurrent lumbar surgery, including spinal fusion, laminectomy, and additional discectomy.
  
  
  RESULTS
  Analysis of data obtained from 13,654 patient records revealed a rate of additional lumbar surgeries after single-level discectomy of 3.95% (539/13654) within 3 months and 12.2% (766/6274) within 4 years of the index procedure. Lumbar spinal fusion was performed on 5.9% (370/6274) of patients within 4 years. Patients who received a re-exploration discectomy within 2 years of the index procedure went on to receive lumbar fusion at a rate of 38.4% (48/125) within the 4 years after the re-exploration discectomy. The average additional cost of lumbar reoperation, as measured by insurance reimbursement, was approximately $11,161 per-patient per year.
  
  
  CONCLUSIONS
  We report an overall 4-year reoperation rate of 12.2% after single-level discectomy. In addition, we report a rate of progression to lumbar fusion following re-exploration discectomy of 38.4% within 4 years of reoperation. Further studies are needed regarding the best treatment algorithm in patients with reherniation or iatrogenic instability after lumbar discectomy. This study should enhance the shared decision making process by providing surgeons and patients with valuable data regarding the frequency and nature of reoperations after discectomy.
  
  
  METHODS
  3.
authors.affiliation: Departments of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Heindel
authors.affiliation: Departments of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Tuchman
authors.affiliation: Departments of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.
authors.forename: Patrick C
authors.initials: PC
authors.lastname: Hsieh
authors.affiliation: Departments of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.
authors.forename: Martin H
authors.initials: MH
authors.lastname: Pham
authors.affiliation: Departments of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.
authors.forename: Anthony
authors.initials: A
authors.lastname: D'Oro
authors.affiliation: Departments of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.
authors.forename: Neil N
authors.initials: NN
authors.lastname: Patel
authors.affiliation: Departments of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.
authors.forename: Andre M
authors.initials: AM
authors.lastname: Jakoi
authors.affiliation: Departments of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.
authors.forename: Ray
authors.initials: R
authors.lastname: Hah
authors.affiliation: Departments of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.
authors.forename: John C
authors.initials: JC
authors.lastname: Liu
authors.affiliation: Departments of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.
authors.forename: Zorica
authors.initials: Z
authors.lastname: Buser
authors.affiliation: Departments of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D016208:Databases, Factual; D017586:Diskectomy / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000453:epidemiology* / Q000601:surgery; D007796:Laminectomy / Q000706:statistics & numerical data; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011843:Radiculopathy / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D012008:Recurrence; D012086:Reoperation / Q000639:trends*; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D055815:Young Adult