Type of index operation not linked to need for revision surgery in degenerative lumbar spinal stenosis

Switzerland: A new cohort study found no significant association between type of index operation and need for revision surgery after 3 years among patients with degenerative lumbar spinal stenosis (DLSS).

The study was published in the JAMA Network Open.

Lumbar spinal stenosis is a spinal canal narrowing, compressing the nerves traveling through the lower back into the legs, most commonly affecting people aged 60 and older. It can be treated conservatively with pain-relieving agents or aggressively with decompressive surgery. There has been a remarkable increase in decompression and fusion surgery for degenerative lumbar spinal stenosis (DLSS). The increase in operation rates could lead to more patients needing revision surgery, resulting in intraoperative or postoperative complications, bone fusion failures, the persistence of pain, or additional progressive degeneration such as adjacent segments disease. Also, the need for revision surgery adds to the financial and resource burden. Only limited data derived from extensive prospective cohort studies exist on the incidence of revision surgery among patients who undergo operations for degenerative lumbar spinal stenosis (DLSS).

Ulrich NH, University of Zurich, Zurich, Switzerland, and his research team conducted a study to assess the cumulative incidence of revision surgery after 2 types of index operations decompression alone or decompression with fusion among patients with DLSS.

The research team analyzed data of 328 patients aged 50 years or older with DLSS from the Lumbar Stenosis Outcome Study. Of the total, 256 underwent decompression alone and 72 underwent fusion surgery. The primary outcome was the cumulative incidence of revision operations. Secondary outcomes included changes in the following patient-reported outcome measures: Spinal Stenosis Measure (SSM) symptom, physical function subscale scores, and the EuroQol Health-Related Quality of Life 5-Dimension 3-Level questionnaire (EQ-5D-3L) summary index score.

Key findings of the analysis:

• The cumulative incidence of revisions after 3 years of follow-up was 11.3% for the decompression alone group and 13.9% for the fusion group.

• There was no significant difference in the need for revision between the 2 groups over time (adjusted hazard ratio-1.40)

• The number of revisions was significantly associated with higher SSM symptom severity scores (β, 0.171) and lower EQ-5D-3L summary index scores (β, −0.061) but not with higher SSM physical function scores (β, 0.068).

• The type of index operation was not significantly associated with the corresponding outcomes.

The authors conclude that there is no significant association between the type of index operation for DLSS—decompression alone or fusion—and the need for revision surgery or the outcomes of pain, disability, and quality of life among patients after 3 years. The number of revision operations was associated with more pain and worse quality of life.

Reference:

Ulrich NH, Burgstaller JM, Valeri F, et al. Incidence of Revision Surgery After Decompression With vs Without Fusion Among Patients With Degenerative Lumbar Spinal Stenosis. JAMA Netw Open. 2022;5(7):e2223803. doi:10.1001/jamanetworkopen.2022.23803