Impact of the number of previous lumbar operations on patient-reported outcomes after surgery for lumbar spinal stenosis or lumbar disc herniation

Author:

Riksaasen Anniken S.1ORCID,Kaur Simran2,Solberg Tore K.13,Austevoll Ivar4ORCID,Brox Jens-Ivar5ORCID,Dolatowski Filip C.6ORCID,Hellum Christian6,Kolstad Frode7ORCID,Lonne Greger8910ORCID,Nygaard Øystein P.810,Ingebrigtsen Tor1311ORCID

Affiliation:

1. Faculty of Health Sciences, Department of Clinical Medicine, University of Tromsø - the Arctic University of Norway, Tromsø, Norway

2. Martina Hansens Hospital, Sandvika, Norway

3. Department of Neurosurgery and the Norwegian Registry for Spine Surgery, University Hospital of North Norway, Tromsø, Norway

4. Orthopedic Department, Kysthospitalet in Hagevik, Haukeland University Hospital, Bergen, Norway

5. Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway

6. Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway

7. Department of Neurosurgery, Oslo University Hospital, Oslo, Norway

8. Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway

9. Innlandet Hospital Trust, Brumunddal, Norway

10. Department of Neurosurgery, St. Olavs Hospital and the National Advisory Unit on Spinal Surgery, Trondheim, Norway

11. Australian Institute of Health Innovation, Macquarie University, Sydney, Australia

Abstract

AimsRepeated lumbar spine surgery has been associated with inferior clinical outcomes. This study aimed to examine and quantify the impact of this association in a national clinical register cohort.MethodsThis is a population-based study from the Norwegian Registry for Spine surgery (NORspine). We included 26,723 consecutive cases operated for lumbar spinal stenosis or lumbar disc herniation from January 2007 to December 2018. The primary outcome was the Oswestry Disability Index (ODI), presented as the proportions reaching a patient-acceptable symptom state (PASS; defined as an ODI raw score ≤ 22) and ODI raw and change scores at 12-month follow-up. Secondary outcomes were the Global Perceived Effect scale, the numerical rating scale for pain, the EuroQoL five-dimensions health questionnaire, occurrence of perioperative complications and wound infections, and working capability. Binary logistic regression analysis was conducted to examine how the number of previous operations influenced the odds of not reaching a PASS.ResultsThe proportion reaching a PASS decreased from 66.0% (95% confidence interval (CI) 65.4 to 66.7) in cases with no previous operation to 22.0% (95% CI 15.2 to 30.3) in cases with four or more previous operations (p < 0.001). The odds of not reaching a PASS were 2.1 (95% CI 1.9 to 2.2) in cases with one previous operation, 2.6 (95% CI 2.3 to 3.0) in cases with two, 4.4 (95% CI 3.4 to 5.5) in cases with three, and 6.9 (95% CI 4.5 to 10.5) in cases with four or more previous operations. The ODI raw and change scores and the secondary outcomes showed similar trends.ConclusionWe found a dose-response relationship between increasing number of previous operations and inferior outcomes among patients operated for degenerative conditions in the lumbar spine. This information should be considered in the shared decision-making process prior to elective spine surgery.Cite this article: Bone Joint J 2023;105-B(4):422–430.

Publisher

British Editorial Society of Bone & Joint Surgery

Subject

Orthopedics and Sports Medicine,Surgery

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