Return to work prolonged with arthrodesis vs revision discectomy for recurrent disc herniation

NEW ORLEANS — When patients present with recurrent lumbar disc herniation after primary discectomy for disc herniation, standalone revision discectomy performed at the same level may be their best treatment option, particularly in the absence of back dominant complaints, listhesis or spinal instability, according to a presenter, here.

“Using a national prospective quality of life registry, arthrodesis is being frequently performed for recurrent single-level disc herniation (DH), particularly in patients who present with a significant back pain component, even without spondylolisthesis or mechanical instability,” Matthew J. McGirt, MD, said at the Congress of Neurological Surgeons Annual Meeting. “Arthrodesis is associated with greater health care utilization and morbidity, but also with a trend of reduced 3-month reoperations, but equivalent 1-year reported outcomes.”

McGirt and colleagues used the National Neurosurgery Quality and Outcomes Database to determine the utilization and outcomes of arthrodesis for recurrent lumbar DH compared to standalone discectomy in 417 patients with recurrent DH enrolled prospectively in the database. About one third of patients were treated with arthrodesis and two thirds were treated with discectomy.

The two cohorts where similar, McGirt said, despite some minor differences, such as more severe back than leg symptoms in the arthrodesis group.

“When you compare perioperative outcomes and safety measures, as you would imagine, the length of surgery was twice more, if not three times as long for fusion. Blood loss at about seven times greater. Length of stay, on average, was 3 days greater, one vs. three median stay” in the arthrodesis group, McGirt said.

However, readmissions, reoperations, hospital costs at 90 days postoperatively and locations to where patients were discharged were similar for both procedures.

“Perioperative major adverse events were nearly 4% vs 1.4%” for the arthrodesis and discectomy groups, respectively, a difference that was not significant, according to McGirt.

One area where the investigators started to see a difference between procedures was return to work, which relates to pain, as well as disability outcomes. The results showed arthrodesis was associated with prolonged return to work, which is an endpoint stakeholders focus on increasingly today in the era of health care reform, McGirt noted. – by Susan M. Rapp

Reference:

McGirt MJ, et al. Paper #110. Presented at: Congress of Neurological Surgeons Annual Meeting; Sept. 26-30, 2015; New Orleans.

Disclosure: McGirt reports he is a consult for Biomet, DePuy Synthes and Stryker.