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. 2020 Oct;10(7):832-836.
doi: 10.1177/2192568219878132. Epub 2019 Sep 25.

Clinical Outcomes of Decompression Alone Versus and Decompression and Fusion for First Episode Recurrent Disc Herniation

Leah Y Carreon  1 , Erica F Bisson  2 , Eric A Potts  3 , Morgan E Brown  1 , Stacie Gren  3 , Rebecca Ruegg Cowan  3 , Steven D Glassman  1
Affiliations

Clinical Outcomes of Decompression Alone Versus and Decompression and Fusion for First Episode Recurrent Disc Herniation

Leah Y Carreon et al. Global Spine J. 2020 Oct.

Abstract

Study design: Longitudinal cohort.

Objective: It is unclear if patients with a recurrent disc herniation benefit from a concurrent fusion compared with a repeat decompression alone. We compared outcomes of decompression alone (D0) versus decompression and fusion (DF) for recurrent disc herniation.

Methods: Patients enrolled in the Quality and Outcomes Database from 3 sites with a first episode of recurrent disc herniation were identified. Demographic, surgical, and radiographic data including the presence of listhesis and extent of facet resection on computed tomography or magnetic resonance imaging prior to the index surgery were collected. Patient-reported outcomes were collected preoperatively and at 3 and 12 months postoperatively.

Results: Of 94 cases identified, 55 had D0 and 39 had DF. Patients were similar in age, sex distribution, smoking status, body mass index, American Society of Anesthesiologists grade and surgical levels. Presence of listhesis (D0 = 7, DF = 5, P = .800) and extent of facet resection (D0 = 19%, DF = 16%, P = .309) prior to index surgery were similar between the 2 groups. Estimated blood loss (D0 = 26 cm3, DF = 329 cm3, P < .001), operating room time (D0 = 79 minutes, DF = 241 minutes, P < .001) and length of stay (D0 <1 day, DF = 4 days, P < .001) were significantly less in the D0 group. Preoperative and 1-year postoperative patient-reported outcomes were similar in both groups. Three patients in the D0 group and 2 patients in the DF group required revision. Regression analysis showed that presence of listhesis, extent of facet resection and fusion were not associated with the 12-month Oswestry Disability Index (ODI) score.

Conclusion: For a first episode recurrent disc herniation, surgeons can expect similar outcomes whether patients are treated with decompression alone or decompression and fusion.

Keywords: decompression and fusion; discectomy; patient-reported outcomes; recurrent disc herniation; decompression; revision surgery.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: SG and RRC have no relationships to disclose. LYC: AO Spine: Paid consultant, Editorial Advisory Board Spine, The Spine Journal: Editorial or governing board, Norton Healthcare: Employee, board or committee member, Spine Deformity: Editorial or governing board, Trips and Travel from Center for Spine Surgery and Research, University of Denmark: Other financial or material support, University of Louisville Institutional Review Board: Board or committee member. EFB: AANS Ethics, AANS/CNS Spine SPC: Board or committee member, Journal of Neurosurgery: Spine: Editorial or governing board, MiRus: Paid consultant, nView: Paid consultant; stock or stock options. EAP: AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves: Board or committee member, Medtronic: IP royalties; paid consultant. SDG: K2M: Paid consultant, Medtronic: IP royalties; paid consultant, Scoliosis Research Society: Board or committee member. MEB, LYC, and SDG: Institutional research support from Pfizer, Lifesciences Corporation, IntelliROD, Cerapedics: Research support, Scoliosis Research Society, National Institutes of Health, Fischer-Owen Kotcamp Fund, International Spine Study Group, Texas Scottish Rite Hospital.

Figures

Figure 1.
Figure 1.
The extent of resection determined by comparing (a) the width of the resected facet to the (b) width of the contralateral facet at the level of decompression expressed as a percentage (width of the resected facet/width of the contralateral facet; a/b.
See this image and copyright information in PMC

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