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IF 2.6 2区医学 Q2 CLINICAL NEUROLOGY

Spine Pub Date : 2025-03-13 DOI:10.1097/BRS.0000000000005328

Suhas K Etigunta, Andy M Liu, Adeesya Gausper, Vivien Chan, Justin Scheer, Tiffany Perry, David L Skaggs, Corey Walker, Alexander Tuchman

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引用次数: 0

摘要

研究设计回顾性队列研究：本研究旨在评估单层腰椎间盘切除术后的再手术率：单层腰椎间盘切除术后的再手术率存在争议，有报道称再手术率在 5-24% 之间。准确描述这些比率对于提供者和患者教育至关重要：方法：我们使用 PearlDiver 数据库进行了一项回顾性分析。方法：利用 PearlDiver 数据库进行了一项回顾性分析，纳入了单层腰椎间盘切除术后随访至少五年的 18 岁或以上患者。主要结果是五年后的腰椎手术率。次要分析评估了翻修椎间盘切除术后的后续腰椎手术、初次或翻修椎间盘切除术后的腰椎融合率以及后续腰椎手术的风险因素。研究采用了卡普兰-梅耶分析和考克斯回归模型：结果：本研究共纳入了 308 979 名患者。五年后的腰椎手术率为 14.4%，五年后的腰椎融合术率为 6.1%。有 67098 名患者接受了翻修椎间盘切除术。其中，五年后接受腰椎手术的比例为 18.2%，五年后接受腰椎融合术的比例为 12.4%。Kaplan-Meier曲线显示，在初次和翻修椎间盘切除术后的第一年内，避免后续腰椎手术的概率下降得更快。Cox回归确定肥胖（HR=1.12，95% CI=[1.097，1.141]）和较高的Elixhauser合并症指数（HR=1.06，95% CI=[1.060，1.068]）是指数椎间盘切除术后进行后续腰椎手术的重要预测因素：结论：单水平腰椎间盘切除术后五年的后续腰椎手术率为14.4%，翻修椎间盘切除术后的后续腰椎手术率更高，为18.2%。这是迄今为止研究单层腰椎间盘切除术后再手术率的最大队列。应告知患者后续手术的巨大风险，尤其是在翻修椎间盘切除术后。翻修椎间盘切除术后更常进行融合手术，这强调了在复发性腰椎间盘突出症病例中仔细考虑手术计划和患者选择的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Long-Term Reoperation Rates After Single-Level Lumbar Discectomy: A Nationwide Cohort Study.

Study design: Retrospective Cohort Study.

Objective: This study aims to evaluate reoperation rates following single-level lumbar discectomy.

Summary of background data: Reoperation rates following single-level lumbar discectomy are debated, with reports ranging from 5-24%. Accurately characterizing these rates is essential for provider and patient education.

Methods: A retrospective analysis was conducted using the PearlDiver database. Patients aged 18 or older with minimum five years follow-up after a single-level lumbar discectomy were included. The primary outcome was subsequent lumbar surgery rate at five years. Secondary analysis evaluated subsequent lumbar surgery following revision discectomy, lumbar fusion rate after primary or revision discectomy, and risk factors for subsequent lumbar surgery. Kaplan-Meier analysis and Cox regression models were employed.

Results: There were 308,979 patients included in this study. The five-year subsequent lumbar surgery rate was 14.4% and the five-year subsequent lumbar fusion rate was 6.1%. There were 67,098 patients who received revision discectomy. Of those, five-year subsequent lumbar surgery rate was 18.2% and subsequent lumbar fusion rate was 12.4%. Kaplan-Meier curves demonstrated that the probability of avoiding subsequent lumbar surgery decreased more rapidly within the first year following both index and revision discectomy. Cox regression identified obesity (HR=1.12, 95% CI=[1.097, 1.141]) and higher Elixhauser Comorbidity Index (HR=1.06, 95% CI=[1.060, 1.068]) as significant predictors of subsequent lumbar surgery following index discectomy.

Conclusion: Five-year subsequent lumbar surgery rate following single-level lumbar discectomy was 14.4%, with a higher rate of 18.2% following revision discectomy. This is the largest cohort to date studying reoperation rates after single-level lumbar discectomy. Patients should be counseled regarding the significant risk of subsequent surgeries, particularly after revision discectomy. Fusion procedures were more frequently performed after revision discectomy, underscoring the need to carefully consider surgical planning and patient selection in recurrent lumbar disc herniation cases.

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来源期刊

Spine 医学-临床神经学

CiteScore

5.90

自引率

6.70%

发文量

361

审稿时长

6.0 months

期刊介绍： Lippincott Williams & Wilkins is a leading international publisher of professional health information for physicians, nurses, specialized clinicians and students. For a complete listing of titles currently published by Lippincott Williams & Wilkins and detailed information about print, online, and other offerings, please visit the LWW Online Store. Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of Spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. The Journal does not publish articles reporting material that has been reported at length elsewhere.