Reoperation Rates After Lumbar Discectomy in Pediatric Patients.

Abstract

Background: Lumbar disc herniation (LDH) is uncommon in the pediatric population but can cause significant low-back or radicular pain and, at times, neurological deficits. We aimed to study discectomy operations in pediatric patients to provide insight into surgical outcomes that may inform clinical decision-making and patient counseling.

Methods: A national insurance claims database (PearlDiver) was queried to identify pediatric patients (<21 y old) who underwent discectomy. Procedures were characterized by demographics features, including age of patient, year, and location. Reoperations was defined as discectomy, re-exploration discectomy, fusion, or laminectomy occurring within 5 years of the initial discectomy. A subsequent parallel analysis looked at reoperations following re-exploration discectomies. Kaplan-Meier survival and cox proportional regression analyzed factors impacting survival postprimary discectomy.

Results: A total of 4410 primary discectomy patients were identified, with an overall 12% reoperation rate within 5 years of the initial discectomy. Specifically, patients under 18 and between the ages of 18 and 21 having a reoperation rate of 7% (115 patients) and 15% (406 patients), respectively. The incidence of discectomy operations increased with patient age. 78% of pediatric cases were performed on an outpatient basis compared with 75% of adult cases. The rate of reoperation was highest within the first year postdiscectomy, with nearly half of reoperations occurring in this time. Specifically, reoperation rates were 2.3% at 3 months, 4% at 6 months, 6% at 1 year, 7% at 2 years, and 12% at 5 years. The most common reoperation procedure was another discectomy. The reoperation rates following these revision operations were 2% at 3 months, 4% at 6 months, 6% at 1 year, 10% at 2 years, and 14% by 5 years. Fusion was the most common procedure following a failed revision discectomy (42% at 5 y). The Kaplan-Meier survival analysis similarly showed most procedures occurred in the first 3 years, with obesity and Elixhauser Comorbidity Index inversely correlated with survival.

Conclusions: Overall, pediatric reoperation rates following discectomy are 11.8%. Obesity and Elixhauser Comorbidity Index significantly increased risk of reoperation. This study provides real-world, large-scale data that may guide surgeons caring for pediatric patients undergoing microdiscectomy.

Level of evidence: Level III.