Jeffrey C. Wang, MD, co-director of the USC Spine Center at Keck Medicine of USC in Los Angeles, will present findings from the study, "Reoperation Rates Following Single-Level Lumbar Discectomy," at the North American Spine Society annual meeting in Boston on Oct. 26.
Since a lumbar herniated disc proves a common problem for patients, Dr. Wang and his team sought to collect data on lumbar discectomy patient outcomes. The study involved data from 13,654 patients undergoing single-level lumbar discectomy. The researchers also identified subsequent recurrent lumbar surgeries, like spinal fusion, laminectomy and additional discectomy.
Here are four key findings:
1. The researchers found a reoperation rate of 12.2 percent following single-level discectomy. This rate is consistent with findings from previous studies.
"It confirms what we know already, but we weren't really sure about," he adds, noting as time progresses, more of the patients will require surgery.
2. The study also revealed a 38.4 percent rate of progression to lumbar fusion after a re-exploration discectomy within four years of reoperation. This finding surprised Dr. Wang and his team somewhat.
About two decades ago, Dr. Wang remembers his superiors informing him that about 15 percent of people will need a spinal fusion sometime in their lifetime. Based on the study's four-year follow-up, however, only about 5.9 percent of patients required a fusion in four years.
"That's a pretty low rate, since about 94 percent [of people] don't need [a fusion] at four years," Dr. Wang says.
3. Regarding the 38.4 percent progression rate, Dr. Wang recalls the industry-wide controversy he saw during training about whether to perform a fusion or revision discectomy on patients who had a discectomy and a recurrence.
"[This study] may tell us that if patients are pretty degenerative, we have to tell them there's a high chance that if they have revision surgery, they are going to need a fusion," says Dr. Wang. "I think that fact alone will change and affect people who are making decisions on doing revision surgeries."
4. Dr. Wang concludes the study allows providers to reassure patients with herniated discs that their reoperation risk at four years is low. After four years, the risk of revision surgery escalates.
"The biggest impact will be for the people who have had one surgery and are trying to decide whether to do a fusion or not," explains Dr. Wang. "Because it's such a high risk of needing fusion down the line, they will look at factors that decide needing a fusion."
The depersonalization of such a large dataset is a disadvantage of the study, since it's impossible to assess individualized data. The large patient population, however, offers the possibility of identifying a real trend.
"The huge advantage is the huge numbers," explains Dr. Wang. "If you find the trend, it's probably real, and that's the power of it."
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