Friday, September 28, 2018 3:00 PM–4:00 PM abstracts: optimizing lumbar disc surgery: 218. Patients undergoing revision microdiscectomy for recurrent lumbar disc herniation experience worse clinical outcomes and more reoperations compared to patients undergoing a primary microdiscectomy

Abstract

BACKGROUND CONTEXT When conservative measures fail, lumbar disc herniation has been shown to be successfully treated by a microdiscectomy surgery. The percentage of patients that necessitate revision surgery within 2years varies between 0.5% and 24% in literature, with recurrent herniation being the most common presentation.However, in the setting of a revision discectomy surgery for a recurrent disc herniation, outcomes can be more difficult to predict. Some studies with smaller patient populations and diverse outcome protocols have not found significant clinical outcome differences between these two patient populations. Other studies have begun to elucidate differences at 1 year after surgery. PURPOSE The goal of this study is the compare the demographics and outcomes of patients undergoing primary lumbar microdiscectomy surgery for a disc herniation and those undergoing a revision microdiscectomy surgery for a recurrent disc herniation. STUDY DESIGN/SETTING Retrospectivec cohort series. PATIENT SAMPLE We performed a retrospective analysis of patients who underwent a primary or revision lumbar microdiscectomy between 2009 and 2015 by one of two senior orthopaedic spine surgeons. Patients were excluded from analysis if they had any previous lumbar surgery (other than a microdiscectomy at the recurrent disc herniation level), were under 18 years of age at the time of surgery, or had postoperative follow up less than 3 months. Patients were divided into two groups: those undergoing a primary surgery for a lumbar disc herniation (primary) and those undergoing a revision procedure for a recurrent disc herniation (recurrent). OUTCOME MEASURES Patient reported outcomes were obtained in the form of Oswestry Disability Index (ODI) scores, Visual Analog Scales (VAS) scores for the back and leg, 12-Item Short Form Mental and Physical Survey (SF-12) scores, and the Veterans Rand 12-Item Health Mental and Physical Survey (VR-12) scores. Patients were also surveyed about their expectations and satisfactions following surgery. METHODS Baseline patient characteristics were compared using chi-squared analysis and independent sample t-tests for categorical and continuous data, respectively. Bivariate and multivariate regressions were subsequently used to compare clinical outcomes between procedure groups. Multivariate analyses controlled for differences in baseline patient characteristics. RESULTS Overall, 296 consecutive patients who fulfilled our inclusion criteria were assessed. The patients in the recurrent group were significantly younger than those in the primary group (44.6±12.7 vs. 53.2±16.2 years; p CONCLUSIONS Patients who presented with symptoms related to a recurrent lumbar disc herniation underwent surgery significantly sooner than those patients who underwent a primary lumbar microdiscectomy for a disc herniation. At 2 years following surgery, patients that underwent a revision lumbar microdiscectomy for a recurrent disc herniation reported significantly worse patient outcomes following surgery. These patients that underwent revision surgery were also significantly less satisfied and felt as though their results did not exceed nor meet their expectations of the procedure. Revision rates were also significantly higher in patients undergoing a revision lumbar microdiscectomy. Although three-quarters or patients will not require a repeat operation following a revision microdiscectomy, preoperative educations should be clearly communicated regarding the elevated risk of a subsequent reherniation and/or worse back pain as well as expectations following this revision procedure.