Risk Factors and Reoperation Rate in Revision Lumbar Disc Herniation Surgery: A Systematic Review and Meta-Analysis of 1,031,348 Patients

Abstract

Study DesignA systematic review and meta-analysis.ObjectivesTo estimate reoperation rate after lumbar disc herniation surgery and identify associated risk factors.MethodsWe searched PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Scopus, and Embase to April 2025 for English-language randomized controlled trials and observational studies reporting risk factors and reoperation rates. Two reviewers independently screened studies, extracted data, and assessed quality using the Newcastle-Ottawa Scale and Cochrane Risk of Bias 2.0 tool. Meta-analysis used fixed-effect model.ResultsTwenty-five studies (1,031,348 patients) met the inclusion criteria. The pooled reoperation rate was 8.5% (95% CI: 6.2%-11.6%), rising with follow-up: 4% at ≤1 year, 11.1% at 1-5 years, and 8.8% beyond 5 years (P < 0.0001 for subgroup differences). Smoking (OR 1.39; 95% CI: 1.09-1.78), older age (OR 1.52; 95% CI: 1.25-1.85), and large annular defect size (OR 2.19; 95% CI: 1.07-4.48) were significant risk factors; sex was not (OR 1.22; 95% CI: 0.96-1.55). Diabetes and certain surgical techniques were also linked to higher risk in individual studies. Adjustment for publication bias increased the overall pooled rate to 10.3% (95% CI: 7.6%-14.0%).ConclusionsReoperation rates after lumbar disc herniation surgery differ by follow-up duration: 4% at ≤1 year, 11.1% at 1-5 years, and 8.8% beyond 5 years. Smoking, older age, diabetes, and large annular defects were significant risk factors. Recognizing high-risk patients can support decisions for extended conservative care or closer follow-up. Further studies should compare revision techniques to improve long-term outcomes.

Keywords: lumbar disc herniation; meta-analysis; reoperation; risk factors.

Figure 1.

PRISMA Flow Diagram 2020. *Consider, If Feasible to Do So, Reporting the Number of Records Identified From Each Database or Register Searched (Rather Than the Total Number Across All Databases/Registers). **If Automation Tools Were Used, Indicate How Many Records Were Excluded by a Human and How Many Were Excluded by Automation Tools. Source: Page MJ, et al. BMJ 2021;372:n71. doi: 10.1136/bmj.n71. This Work is Licensed Under CC BY 4.0. To View a Copy of This License, Visit https://creativecommons.org/licenses/by/4.0/

Figure 2.

Risk of Bias Assessment of Included Studies

Figure 3.

(A) Forest Plot for the Association Between Smoking and the Odds of Revision Surgery (B) Forest Plot for the Association Between Sex and the Odds of Revision Surgery (C) Forest Plot for the Association Between Age and the Odds of Revision Surgery (D) Forest Plot for the Association Between Annular Defect Size and the Odds of Revision Surgery

Figure 4.

(A) Forest Plot of Pooled Reoperation Rates by Follow-up Duration (Before Adjustment) (B) Forest Plot of Pooled Reoperation Rate (After Adjustment) (C) Funnel Plot for Assessment of Publication Bias (After Adjustment)