Do revision lumbar spine procedures lead to worse postoperative outcomes? A systematic review with a meta-analysis of patient-reported outcomes.

Abstract

Introduction: Revision lumbar spine surgery is increasingly performed for recurrent disc herniation, adjacent segment disease, and pseudarthrosis, yet comparative outcomes with primary procedures remain incompletely characterized. This systematic review compared perioperative complications, patient-reported outcomes (PROs), and reoperation risk between primary and revision lumbar surgery.

Materials and methods: A Preferred Reporting Items for Systematic reviews and Meta-Analyses-compliant systematic review of PubMed was conducted through July 28, 2025. Studies published after 2000 comparing adult patients undergoing primary versus revision lumbar surgery were included. Data extraction and quality assessment using the Newcastle-Ottawa Scale were performed independently by reviewers. Random-effects meta-analyses were conducted for outcomes reported in at least three studies.

Results: Thirty-six studies met inclusion criteria, including lumbar fusion (n = 21), discectomy (n = 11), and complex deformity surgery (n = 4). Revision patients consistently had worse baseline pain and disability. In fusion cohorts, both groups improved postoperatively, but revision surgery was associated with worse absolute PROs and greater perioperative morbidity. Meta-analysis demonstrated a small advantage for primary surgery in 6-month Oswestry Disability Index scores (mean difference: 2.9, 95% confidence interval: 0.42-5.38), which was not maintained at 12 months. Revision discectomy was associated with higher complication and reoperation rates and poorer long-term PROs. Across procedure types, revision surgery demonstrated higher rates of infection, dural tears, thromboembolic events, and blood transfusion.

Conclusions: Revision lumbar surgery is associated with greater perioperative risk and lower absolute functional outcomes than primary procedures, although most patients achieve meaningful postoperative improvement. Careful patient selection and preoperative expectation management remain essential.

Level of evidence: III.