Reoperation for Recurrent Intervertebral Disc Herniation in the Spine Patient Outcomes Research Trial: Analysis of Rate, Risk Factors, and Outcome.
METHODS
This study was a post-hoc subgroup analysis of prospectively collected data in the Spine Patient Outcomes Research Trial (SPORT).


OBJECTIVE
The aim of this study was to determine the risk factors for and to compare the outcomes of patients undergoing revision disc excision surgery in SPORT.


BACKGROUND
Risk factors for reherniation and outcomes after revision surgery have not been well-studied. This information is critical for proper patient counseling and decision-making.


METHODS
Patients who underwent primary discectomy in the SPORT intervertebral disc herniation cohort were analyzed to determine risk factors for undergoing revision surgery. Risk factors for undergoing revision surgery for reherniation were evaluated using univariate and multivariate analysis. Primary outcome measures consisted of Oswestry Disability Index (ODI), the Sciatica Bothersomeness index (SBI), and the Short Form 36 (SF-36) at 6 weeks, 3 months, 6 months, and yearly to 4 years.


RESULTS
Of 810 surgical patients, 74 (9.1%) received revision surgery for reherniation. Risk factors for reherniation included: younger age (hazard ratio [HR] 0.96 [0.94-0.99]), lack of a sensory deficit (HR 0.61 [0.37-0.99]) lack of motor deficit (HR 0.54 [0.32-0.91]), and higher baseline ODI score (HR 1.02 [1.01-1.03]). The time-adjusted mean improvement from baseline to 4 years was less for the reherniation group on all outcome measures (Bodily Pain Index [BP] 39.5 vs. 44.9, P = 0.001; Physical Function Index [PF] 37.1 vs. 44.5, P < 0.001; ODI 33.9 vs. 38.3, P < 0.001; SBI 8.7 vs. 10.5, P < 0.001). At 4 years, only SBI (-9 vs. -11.4, P = 0.002) was significantly lower in the reherniation group.


CONCLUSIONS
Younger patients with higher baseline disability without neurological deficit are at increased risk of undergoing revision surgery for reherniation. Those considering revision surgery for reherniation will likely improve significantly following surgery, but possibly not as much as with primary discectomy.


METHODS
3.
The University of New England College of Osteopathic Medicine, Biddeford, ME.
Robert W
RW
Abdu
Department of Orthopedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
William A
WA
Abdu
Department of Orthopedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Adam M
AM
Pearson
Geisel School of Medicine at Dartmouth, Lebanon, NH.
Wenyan
W
Zhao
The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH.
Jon D
JD
Lurie
Dartmouth-Hitchcock Health System, Lebanon, NH.
James N
JN
Weinstein
D000328:Adult; D017586:Diskectomy / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000453:epidemiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011843:Radiculopathy / Q000453:epidemiology / Q000601:surgery; D012008:Recurrence; D012086:Reoperation; D012307:Risk Factors; D016896:Treatment Outcome