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Reoperation Rates After Single-level Lumbar Discectomy

Heindel, Patrick BS; Tuchman, Alexander MD; Hsieh, Patrick C. MD; Pham, Martin H. MD; D’Oro, Anthony BA; Patel, Neil N. MD; Jakoi, Andre M. MD; Hah, Ray MD; Liu, John C. MD; Buser, Zorica PhD; Wang, Jeffrey C. MD

doi: 10.1097/BRS.0000000000001855
Surgery

Study Design. Retrospective analysis of national insurance billing database.

Objective. To examine trends in reoperation after single-level lumbar discectomy.

Summary of Background Data. 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.

Conclusion. 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.

Level of Evidence: 3

*Departments of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA

Departments of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.

Address correspondence and reprint requests to Zorica Buser, PhD, Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Hoffman Medical Research Center, 2011 Zonal Ave, HMR 710, Los Angeles, CA 90033; E-mail: zbuser@usc.edu

Received 5 February, 2016

Revised 25 July, 2016

Accepted 2 August, 2016

The manuscript submitted does not contain information about medical device (s)/drug (s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, consultancy, royalties, stocks, and grants.

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