The Long-Term Reoperation Rate Following Surgery for Lumbar Herniated Intervertebral Disc Disease

A Nationwide Sample Cohort Study With a 10-Year Follow-Up

Chi Heon Kim, MD, PhD; Chun Kee Chung, MD, PhD; Yunhee Choi, PhD; Min-Jung Kim, MS; Dahae Yim, MS; Seung Heon Yang, MD; Chang Hyun Lee, MD; Jong-Myung Jung, MD; Sung Hwan Hwang, MD; Dong Hwan Kim, MD; Joon Ho Yoon, MD; Sung Bae Park, MD, PhD

Disclosures

Spine. 2019;44(19):1382-1389. 

In This Article

Abstract and Introduction

Abstract

Study Design: A retrospective cohort study of a nationwide sample database.

Objective: The objective of the present study was to compare the long-term incidence of reoperation for lumbar herniated intervertebral disc disease (HIVD) after major surgical techniques (open discectomy, OD; laminectomy; percutaneous endoscopic lumbar discectomy, PELD; fusion).

Summary of Background Data: HIVD is a major spinal affliction; if the disease is intractable, surgery is recommended. Considering both the aging of patients and the chronicity of lumbar degenerative disease, the effect of surgical treatment for the lumbar spine should be durable for as long as possible.

Methods: The National Health Insurance Service-National Sample Cohort (NHIS-NSC) of Republic of Korea was utilized to establish a cohort of adult patients (N = 1856) who underwent first surgery for lumbar HIVD during 2005 to 2007. Patients were followed for 8 to 10 years. Considering death before reoperation as a competing event, reoperation hazards were compared among surgical techniques using the Fine and Gray regression model after adjustment for age, gender, Charlson comorbidity score, osteoporosis, diabetes, the severity of disability, insurance type, and hospital type.

Results: The overall cumulative incidences of reoperation were 4% at 1 year, 6% at 2 years, 8% at 3 years, 11% at 5 years, and 16% at 10 years. The cumulative incidences of reoperation were 16%, 14%, 16%, and 10% after OD, laminectomy, PELD, and fusion, respectively, at 10 years postoperation, with no difference among the surgical techniques. However, the distribution of reoperation types was significantly different according to the first surgical technique (P < 0.01). OD was selected as the reoperation surgical technique in 80% of patients after OD and in 81% of patients after PELD.

Conclusion: The probability of reoperation did not differ among OD, laminectomy, PELD, and fusion during the 10-year follow-up period. However, OD was the most commonly used technique in reoperation.

Level of Evidence: 4

Introduction

Lumbar herniated intervertebral disc disease (HIVD) is a major spinal affliction.[1,2] Surgical treatment is recommended when patients have intractable symptoms due to HIVD.[3–6] Open discectomy (OD) is regarded as a standard surgical technique; however, other techniques, such as fusion surgery, laminectomy, and percutaneous endoscopic lumbar discectomy (PELD), are also applied in accordance with the introduction of minimally invasive spinal surgical techniques, new instruments, and implants.[2–14] Considering both the aging of patients and the chronicity of lumbar degenerative disease, the effect of surgical treatment for the lumbar spine should be maintained for as long as possible. The reoperation rate can be used as a surrogate marker to evaluate the effects of surgery. Martin et al[15] showed that the overall reoperation rates for OD were 10% at approximately 2 years, 15% at 4.5 years, and 20% at 10 years in a population-based study. Many papers have shown the results of each surgical technique, but a technique may not be regarded as standard until its results are supported by a long-term follow-up study.[2–4,11] In Republic of Korea (ROK), all citizens are beneficiaries of the national health insurance system (NHIS).[10,11,14,16] All nationwide inpatient and outpatient data regarding diseases and services (i.e., procedures and operations) are coded and registered in the National Health Insurance Corporation (NHIC) database and the Health Insurance Review & Assessment Service (HIRA) database, thus enabling the performance of population-based studies.[11,14,16] The National Health Insurance Service-National Sample Cohort (NHIS-NSC) of ROK was utilized for the present study.[17] The objective of the present study was to compare the long-term incidence of reoperation among surgical techniques.

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