Study investigates risks for reoperation after spondylolisthesis surgery

Most reoperations occurred at the adjacent and index levels for pseudarthrosis and recurrent stenosis.

Issue: August 2012

SAN FRANCISCO — A subgroup analysis of the SPORT study showed a 14% reoperation rate at 4 years for patients who undergo surgery for degenerative spondylolisthesis and found no link between the risk of revision and traditional factors, such as surgical variables, body mass index and baseline clinical scores.

Perspective from Ryan M. Garcia, MD

“There was no association between obesity, age, smoking, medical comorbidities and reoperation,” E. Patrick Curry, MD, said at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting. “Pseudoclaudication and asymmetric depressed reflexes, if present, were protective against reoperation, but … we are not sure of the clinical implications of that. There was less improvement over the course of 4 years in the patients who required reoperation, but the magnitude of that difference was less at the 4-year follow-up point.”

The investigators studied 391 patients who underwent surgery for degenerative spondylolisthesis and had 4 years follow-up. Of these, 60 patients (14.6%) underwent reoperation. Curry noted that 5% occurred at the adjacent level and 2% were performed at the index level. He also said 5% of reoperations were performed for recurrent stenosis and 1% was for pseudoarthrosis.

A comparison of patients who underwent reoperation to those patients who did not, showed no correlation between the need for revision and clinical factors on exams, straight leg raise, motor weakness, stenosis levels and severity.

The investigators also found no difference between the groups regarding operative time and length of hospital stay. In addition, they discovered no statistically significant differences between the groups whether they underwent decompression alone, fusion with or without instrumentation, multilevel fusion or multilevel decompressions.

“We looked at the change in outcome from scores between the reoperation group and the non-reoperation group, and the area under the curve was significantly different, with worse outcomes for the patients who required reoperation — although this difference decreased over time,” Curry said. “At 4 years, the reoperation group was approaching the non-reoperation group.” – by Gina Brockenbrough, MA

Reference:

Curry EP, Radcliff KE, Hilibrand AS, et al. Reoperation following degenerative spondylo-listhesis surgery: A subgroup analysis of the SPORT. Paper #77. Presented at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting. Feb. 7-11. San Francisco.

For more information:

E. Patrick Curry, MD, can be reached at Thomas Jefferson University Hospital, 1015 Walnut St., Philadelphia, PA 19107; email: epatrickcurry@gmail.com.
Disclosure: Curry has no relevant financial disclosures.

Perspective

Ryan M. Garcia, MD

The authors should be commended for their efforts in analyzing this prospectively collected data. Dr. Hillibrand is certainly an expert in the field of spinal adjacent level disease. I am suspicious that the reoperation rates might have been lower if adjacent segments are critically evaluated and treated more aggressively during the index procedure. Early reoperations have been known to lead to poor patient outcomes and should be avoided at all costs.

Ryan M. Garcia, MD

Duke University

Durham, N.C.

Disclosures: Garcia has no relevant financial disclosures.