Patients with multiple discectomies had high likelihood of subsequent lumbar fusion

BOSTON — Patients who underwent multiple discectomies had a high likelihood of subsequently undergoing lumbar fusion, according to results presented here.

“Our data shows that there is a high likelihood of progression to fusion for patients with multiple discectomies,” Patrick Heindel, BS, said in his presentation here at the National American Spine Society Annual Meeting. “More than one in three patients receiving two discectomies ended up with a fusion.”

Heindel conducted the study with Jeffrey C. Wang, MD, professor of orthopedic surgery and neurosurgery and co-director of the University of South Carolina Spine Center. “[Microdiscectomy] is a successful surgery to begin with, [it] has low reoperation rate,” Wang said in an interview with Spine Surgery Today. “But if you need to have a second surgery, you have a high chance of needing a fusion and that is something to be considered when you are having that second surgery.”

Jeffrey C. Wang

Heindel, Wang and colleagues studied information on more than 13,000 patients who underwent single-level discectomy. Patients were followed up for up to 4 years for subsequent lumbar surgery, including re-exploration discectomy, laminectomy and fusion. Researchers also collected cost data for each patient group.

“Patients received additional lumbar surgeries following single-level discectomy at a rate of approximately 4% within 3 months and 12% in 4 years of the index procedure,” Heindel said.

He noted 6% of patients underwent fusion at 4 years, of which 75% were interbody fusions and about half were multilevel fusions. About a third of reoperations occurred at 3 months, with an increase in the reoperation rate with time, according to Heindel.

Wang said, “[The] reoperation rate was 12%, but the most important thing from this study that I think will help clinicians counsel patients and I think help drive decision-making, is the fact that when we looked at patients who had a microdiscectomy and [then] they had a recurrent disc herniation. So, they had another herniation at the same level and then they had a repeat surgery. [For] those people having repeat surgeries, the critical decision-making is difficult because you are wondering, ‘Do we need to do a fusion or do we just repeat the microdiscectomy?’”

Heindel noted reoperation was expensive, with a $32,000 mean reimbursement per patient having no reoperation over 4 years and for a patient who had at least one reoperation it was about $78,000. Fusion was the most expensive option for reoperation, then followed by laminectomy and discectomy. – by Casey Tingle and Monica Jaramillo

Reference:

Heindel P, et al. Paper #30. Presented at: North American Spine Society Annual Meeting; Oct. 26-29, 2016; Boston.

Disclosure: Heindel reports no relevant financial disclosures. Wang reports he receives royalties from Aesculap, Biomet, Amedica, SeaSpine and Synthes; owns stock in FzioMed and has private investments in Promethean Spine, Paradigm Spine, Benevue, NexGen, Vertiflex, ElectoCore, Surgitech, CoreSpine, Expanding Orthopaedics, Osprey, Bone Biologics, Curative Biosciences and PearlDiver; and is on the board of directors for the North American Spine Society.