Acute Care/Hospitalization

Patients who undergo lumbar spine surgery are likely to have another operation later

Patients considering lumbar spine surgery should be informed that the likelihood of having another spine operation later is substantial. In a new study, Darryl T. Gray, M.D., Sc.D., of the Agency for Healthcare Research and Quality, and colleagues from the University of Washington in Seattle found that about one in five patients who had lumbar spine surgery for degenerative spine disorders underwent another back surgery procedure within the next 11 years. This is higher than commonly reported rates for hip or knee replacement, where 10 percent of patients have a second procedure within 10 years.

Not all reoperations are actually repeat procedures performed at the same operative site. However, those that are imply persistent symptoms, progression of degenerative changes, or treatment complications, explains Dr. Gray. To address this issue, the researchers examined data from Washington State's hospital discharge data, which are contributed to AHRQ's State Inpatient Databases. They identified 24,882 adults who underwent inpatient lumbar surgery for degenerative spine disorders from 1990 to 1993. They had either lumbar decompression surgery or lumbar fusion surgery. A total of 19 percent of patients had another lumbar spine surgery during the subsequent 11 years. Patients with spondylolisthesis had a lower cumulative incidence of reoperation after fusion surgery than after decompression alone (17.1 vs. 28 percent). However, for patients with other diagnoses, the cumulative incidence of reoperation was higher following fusion than following decompression alone (21.5 vs. 18.8 percent).

After fusion surgery, 62.5 percent of reoperations were associated with device complications or unsuccessful fusion rather than with new levels of disease or disease progression. Spinal fusion is sometimes viewed as a definitive procedure that may reduce the need for subsequent surgery. However, this study suggests that, except when performed for spondylolisthesis, fusion procedures for degenerative spine disorders were associated with a higher rate of reoperation beyond 1 year than were decompression procedures alone. Patients and their physicians should consider this when weighing options for treating degenerative diseases of the lumbar spine.

See "Reoperation rates following lumbar spine surgery and the influence of spinal fusion procedures," by Brook I. Martin, M.P.H., Sohail K. Mirza, M.D., M.P.H, Bryan A. Comstock, M.S., and others in the February 2007 Spine 32(3), pp. 382-387. Reprints (AHRQ Publication No. 07-R034) are available from the AHRQ Publications Clearinghouse.

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