J Korean Orthop Assoc.  2013 Aug;48(4):251-257.

Causes and Timing of Reoperation after Thoraco-Lumbar Spine Surgery

Affiliations
  • 1Department of Orthopaedic Surgery, Soon Chun Hyang University Seoul Hospital, Soon Chun Hyang University College of Medicine, Seoul, Korea. schsbj@schmc.ac.kr

Abstract

PURPOSE
We analyzed the patients who needed reoperation after undergoing a thoracolumbar spine operation and investigated the causes, pattern of timing, medical history and clinical outcome after reoperation.
MATERIALS AND METHODS
Out of 2,198 patients who underwent spine surgery for thoracolumbar spine disease from 1988 to 2011, we targeted 193 patients who underwent reoperation. We studied the causes, operative method of initial surgery, time-variant causes and outcome of reoperation.
RESULTS
The number of patients who underwent thoracolumbar spine reoperation was 193 out of 2,198 and the reoperation rate was 8.7%. We researched time-variant causes of reoperation. In six weeks after the initial operation, exploration for hematoma and neurologic deficit was 18 (26.8%), recurred heniated intervertebral disc (HIVD) was 18 (26.8%), and surgical site infection was 17 (25.4%). From six weeks to six months, recurred HIVD was 10 (47.6%), surgical site infection was 7 (33.3%), and after six months, adjacent segmental disease (ASD) was 38 (35.7%), recurred HIVD was 26 (23.2%), and implant related problem was 17 (16.0%).
CONCLUSION
Causes of thoracolumbar spine reoperation included complications (2.8%); infection, hematoma, neurologic deficit, incomplete decompression, and natural courses (5.9%); ASD, recurred HIVD, implant related problem, instability after decompression, tumor recur, progression of deformity.

Keyword

thoracolumbar; spine; reoperation; causes; timing

MeSH Terms

Congenital Abnormalities
Decompression
Hematoma
Humans
Intervertebral Disc
Neurologic Manifestations
Reoperation
Spine

Reference

1. Gray DT, Deyo RA, Kreuter W, et al. Population-based trends in volumes and rates of ambulatory lumbar spine surgery. Spine (Phila Pa 1976). 2006; 31:1957–1963.
Article
2. Taylor VM, Deyo RA, Cherkin DC, Kreuter W. Low back pain hospitalization. Recent United States trends and regional variations. Spine (Phila Pa 1976). 1994; 19:1207–1212.
3. Deyo RA, Gray DT, Kreuter W, Mirza S, Martin BI. United States trends in lumbar fusion surgery for degenerative conditions. Spine (Phila Pa 1976). 2005; 30:1441–1445.
Article
4. Hazard RG. Failed back surgery syndrome: surgical and nonsurgical approaches. Clin Orthop Relat Res. 2006; 443:228–232.
5. Deyo RA, Martin BI, Kreuter W, Jarvik JG, Angier H, Mirza SK. Revision surgery following operations for lumbar stenosis. J Bone Joint Surg Am. 2011; 93:1979–1986.
Article
6. Glassman SD, Carreon LY, Dimar JR, Campbell MJ, Puno RM, Johnson JR. Clinical outcomes in older patients after posterolateral lumbar fusion. Spine J. 2007; 7:547–551.
Article
7. Esses SI, Sachs BL, Dreyzin V. Complications associated with the technique of pedicle screw fixation. A selected survey of ABS members. Spine (Phila Pa 1976). 1993; 18:2231–2238.
Article
8. Deyo RA, Mirza SK, Martin BI, Kreuter W, Goodman DC, Jarvik JG. Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA. 2010; 303:1259–1265.
Article
9. Martin BI, Mirza SK, Comstock BA, Gray DT, Kreuter W, Deyo RA. Reoperation rates following lumbar spine surgery and the influence of spinal fusion procedures. Spine (Phila Pa 1976). 2007; 32:382–387.
Article
10. Jansson KA, Németh G, Granath F, Blomqvist P. Spinal stenosis re-operation rate in Sweden is 11% at 10 years--a national analysis of 9,664 operations. Eur Spine J. 2005; 14:659–663.
11. Wiesel SW. The multiply operated lumbar spine. Instr Course Lect. 1985; 34:68–77.
12. Hanley EN Jr, Shapiro DE. The development of low-back pain after excision of a lumbar disc. J Bone Joint Surg Am. 1989; 71:719–721.
Article
13. Martin BI, Mirza SK, Comstock BA, Gray DT, Kreuter W, Deyo RA. Are lumbar spine reoperation rates falling with greater use of fusion surgery and new surgical technology? Spine (Phila Pa 1976). 2007; 32:2119–2126.
Article
14. Aizawa T, Ozawa H, Kusakabe T, et al. Reoperation for recurrent lumbar disc herniation: a study over a 20-year period in a Japanese population. J Orthop Sci. 2012; 17:107–113.
Article
15. Spengler DM, Freeman C, Westbrook R, Miller JW. Low-back pain following multiple lumbar spine procedures. Failure of initial selection? Spine (Phila Pa 1976). 1980; 5:356–360.
16. Hopp E, Tsou PM. Postdecompression lumbar instability. Clin Orthop Relat Res. 1988; 227:143–151.
Article
17. Bono CM, Lee CK. Critical analysis of trends in fusion for degenerative disc disease over the past 20 years: influence of technique on fusion rate and clinical outcome. Spine (Phila Pa 1976). 2004; 29:455–463.
18. Lurie JD, Weinstein JN. Shared decision-making and the orthopaedic workforce. Clin Orthop Relat Res. 2001; 385:68–75.
Article
19. Etminan M, Girardi FP, Khan SN, Cammisa FP Jr. Revision strategies for lumbar pseudarthrosis. Orthop Clin North Am. 2002; 33:381–392.
Article
20. Katz JN, Lipson SJ, Chang LC, Levine SA, Fossel AH, Liang MH. Seven- to 10-year outcome of decompressive surgery for degenerative lumbar spinal stenosis. Spine (Phila Pa 1976). 1996; 21:92–98.
Article
21. Oertel MF, Ryang YM, Korinth MC, Gilsbach JM, Rohde V. Long-term results of microsurgical treatment of lumbar spinal stenosis by unilateral laminotomy for bilateral decompression. Neurosurgery. 2006; 59:1264–1269.
Article
22. Ciol MA, Deyo RA, Kreuter W, Bigos SJ. Characteristics in Medicare beneficiaries associated with reoperation after lumbar spine surgery. Spine (Phila Pa 1976). 1994; 19:1329–1334.
23. Gerometta A, Rodriguez Olaverri JC, Bitan F. Infections in spinal instrumentation. Int Orthop. 2012; 36:457–464.
Article
24. Collins I, Wilson-MacDonald J, Chami G, et al. The diagnosis and management of infection following instrumented spinal fusion. Eur Spine J. 2008; 17:445–450.
Article
25. Pull ter Gunne AF, Mohamed AS, Skolasky RL, van Laarhoven CJ, Cohen DB. The presentation, incidence, etiology, and treatment of surgical site infections after spinal surgery. Spine (Phila Pa 1976). 2010; 35:1323–1328.
Article
26. Kaner T, Sasani M, Oktenoglu T, Cirak B, Ozer AF. Postoperative spinal epidural hematoma resulting in cauda equina syndrome: a case report and review of the literature. Cases J. 2009; 2:8584.
Article
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