A retrospective cohort study of a nationwide sample database.
The objective of the present study was to compare the long-term incidence of reoperation for lumbar herniated intervertebral disc disease (HIVD) after major surgical techniques (open discectomy, OD; laminectomy; percutaneous endoscopic lumbar discectomy, PELD; fusion).
HIVD is a major spinal affliction; if the disease is intractable, surgery is recommended. Considering both the aging of patients and the chronicity of lumbar degenerative disease, the effect of surgical treatment for the lumbar spine should be durable for as long as possible.
The National Health Insurance Service-National Sample Cohort (NHIS-NSC) of Republic of Korea was utilized to establish a cohort of adult patients (N = 1856) who underwent first surgery for lumbar HIVD during 2005 to 2007. Patients were followed for 8 to 10 years. Considering death before reoperation as a competing event, reoperation hazards were compared among surgical techniques using the Fine and Gray regression model after adjustment for age, gender, Charlson comorbidity score, osteoporosis, diabetes, the severity of disability, insurance type, and hospital type.
The overall cumulative incidences of reoperation were 4% at 1 year, 6% at 2 years, 8% at 3 years, 11% at 5 years, and 16% at 10 years. The cumulative incidences of reoperation were 16%, 14%, 16%, and 10% after OD, laminectomy, PELD, and fusion, respectively, at 10 years postoperation, with no difference among the surgical techniques. However, the distribution of reoperation types was significantly different according to the first surgical technique (P < 0.01). OD was selected as the reoperation surgical technique in 80% of patients after OD and in 81% of patients after PELD.
The probability of reoperation did not differ among OD, laminectomy, PELD, and fusion during the 10-year follow-up period. However, OD was the most commonly used technique in reoperation.
Level of Evidence: 4
The reoperation probabilities for lumbar herniated intervertebral disc disease did not differ among open discectomy, laminectomy, percutaneous endoscopic discectomy, and fusion during the 10-year follow-up period. However, open discectomy was the most commonly used technique in reoperation.
∗Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
†Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea
‡Department of Brain and Cognitive Sciences, Seoul National University Hospital, Seoul, South Korea
§Division of Medical Statistics, Medical Research Collaborating Center, Seoul National University Hospital, Seoul, South Korea
¶Department of Neurosurgery, Seoul National University Bundang Hospital, Bundanggu, South Korea
||Department of Neurosurgery, Seoul National University Boramae Hospital, Boramae Medical Center 20, Seoul, South Korea.
Address correspondence and reprint requests to Chun Kee Chung, MD, PhD, Department of Neurosurgery, Seoul National University College of Medicine, 101 Daehak ro, Jongno-gu, Seoul 110-744, South Korea; E-mail: firstname.lastname@example.org
Received 3 December, 2018
Revised 1 March, 2019
Accepted 23 March, 2019
The first author CH Kim is an consultant of RIWOspine, GmbH.
The manuscript submitted does not contain information about medical device(s)/drug(s).
A grant from the Korea Health Technology R&D Project supported this work through the Korea Health Industry Development Institute (KHIDI) funded by the Ministry of Health & Welfare, Republic of Korea (HC15C1320).
Relevant financial activities outside the submitted work: consultancy, grants.