185. Reoperation rates after single-level lumbar discectomy in the military health system

Abstract

BACKGROUND CONTEXT Despite advances in surgical techniques, rates of recurrent lumbar disc herniation (LDH) range from 5-24%, representing the most common cause of surgical failure and subsequent reoperation. PURPOSE Our goal was to determine the reoperation rate, time to reoperation and type of revision procedures performed after single-level discectomy for LDH within the military health system. STUDY DESIGN/SETTING Restrospective. PATIENT SAMPLE Military health system. METHODS Using CPT codes to capture lumbar microdiscectomy procedures, 3,999 patients undergoing primary single-level microdiscectomy for lumbar disc herniation were identified between October 2012 and November 2017. Demographic data, as well as number and type of revision surgical intervention were investigated. Rates of subsequent procedures involving instrumented fusion and complications were recorded. RESULTS We identified 415 patients (10.3%) who required a revision surgery for a same-level reherniation. Of these patients requiring revision surgery at the same level of the index procedure, 9.3% required more than one revision surgery. The majority of first-time revision procedures consisted of revision microdiscectomy (290/415, 69.9%); however, 125 patients (30.1%) underwent single- or multi-level fusion for definitive treatment at time of first revision. Of the 40 patients requiring more than one revision, 21 (52.5%) eventually required a fusion procedure, which was significantly higher than patients having only one revision (p= CONCLUSIONS In our retrospective study of 3,999 patients undergoing single-level microdiscectomy for lumbar disc herniation, we identified 415 patients (10.4%) undergoing subsequent reoperation for a recurrent LDH at the same level. Within this group, 9.6% would require two or more reoperations, and 52.5% of these patients would ultimately undergo a lumbar arthrodesis at the same level as the initial disc herniation. Our findings characterize the lumbar disc reherniation population in the military, with major implications for the prognosis and treatment strategy of these commonly-treated injuries. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.