JAAOS - 2026-03-15 - Journal Article
Durability of Lumbar Diskectomy: A Survivorship Analysis Based on Revision Surgery Rates.
Crawford CH, Ware W, Mathew J, Gum JL, Owens RK, Djurasovic M, Glassman SD, Carreon LY
Topics
Key Takeaway
16% of lumbar diskectomy patients required unplanned revision surgery at minimum 4-year follow-up, with BMI the only independent predictor (OR 1.042 per unit, p=0.005).
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Summary
This study queried a multisurgeon single-institution database to determine revision rates and indications following primary lumbar diskectomy (CPT 63030). Of 1,133 patients, 185 (16%) underwent unplanned revision; the most common indications were repeat decompression (7% at mean 334 days) and fusion for instability (5% at mean 641 days). Binary logistic regression identified BMI as the sole predictor of revision (OR 1.042; 95% CI 1.01–1.07); age, ASA score, and number of levels were non-significant.
Key Limitation
Absence of patient-reported outcome measures means revision surgery is used as a surrogate for failure, potentially undercounting symptomatic recurrences managed nonoperatively and overcounting elective reoperations.
Original Abstract
INTRODUCTION
Durability of surgical treatment is important to patients, providers, and payers. Lumbar diskectomy is one of the most commonly performed spinal surgeries. Understanding the specific indications for revision surgery can help guide future research and quality improvement initiatives.
METHODS
A multisurgeon, single-institution database was queried for revision surgery following a primary lumbar diskectomy (CPT = 63,030) from 2014 to 2018 with a minimum follow-up of 4 years (N = 1,133). The mean patient age was 44.93 years, levels decompressed was 1.08, mean body mass index was 30.45 kg·m -2 , mean American Society of Anesthesiologists (ASA) score was 2.33, length of stay was 0.44 days, and mean OR time was 115.41 minutes. Primary indication for revision surgery was collected through medical record analysis.
RESULTS
A total of 185 of 1,133 patients (16%) underwent unplanned revision surgery during the study period. The most common indication for revision surgery was repeat decompression (N = 80, 7%) at a mean of 334.2 days postoperatively. The second most common indication was instability requiring fusion (N = 53, 5%) at a mean of 640.89 days postoperatively. Surgery for infection (N = 22, 1.9%) occurred at a mean of 37.77 days postoperatively. Other indications for revision surgery were less common and included: adjacent segment disease (N = 13, 1.1%) at a mean of 682.31 days postoperatively, durotomy repair (N = 13, 1.1%) at a mean of 26.77 days postoperatively, evacuation of hematoma/seroma (N = 4, 0.3%) at a mean of 6.75 days postoperatively. Binary logistic regression showed that age ( P = 0.368), number of surgical levels ( P = 0.694), and ASA grade ( P = 0.152) were not associated with revision surgery. The only factor associated with revision surgery was BMI ( P = 0.005; odds ratio: 1.042; 95% CI, 1.01-1.07).
DISCUSSION
The results of this study show that lumbar diskectomy is a relatively durable procedure (84%) as currently indicated and performed in a large multisurgeon spine center. Early revision surgery (<90 days) for infection, hematoma/seroma, or durotomy repair is rare (3.3%). Late revision surgery (>90 days) for same segment pathology including recurrent stenosis with or without instability (12%) is much more common than adjacent segment disease (1.1%). These data can help guide clinicians and researchers in future quality improvement initiatives.