Document Detail


Reoperations after surgery for lumbar spinal stenosis.
MedLine Citation:
PMID:  21704945     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To study the indication for reoperations after lumbar decompression, the factors predisposing to redo operations, and the effect of prior instrumentation on developing adjacent level stenosis requiring reoperation.
METHODS: Kaplan-Meier analysis was used to compare the median interval to first reoperation. Cox regression was used for multivariate analysis of time to first reoperation.
RESULTS: Of 335 patients who underwent surgery for lumbar spinal stenosis, 63 (18%) underwent instrumentation in addition to decompression. There were 50 reoperations performed in 44 patients (13%). Of these 50 reoperations, 26 were at the same level, 14 were at the same level plus an adjacent level, and 10 were at an adjacent level. In 21 reoperations, the indication was adjacent level spinal stenosis; in 16, adjacent level spinal stenosis plus instability; in 9, instability alone; and in 4, disc problem. The risk of reoperation was higher among male patients (hazard ratio [HR] 1.2, 95% confidence interval [CI] 0.586-2.635) and in patients with prior instrumentation (HR 1.7, 95% CI 0.684-4.640). There was no statistical association between prior instrumentation and subsequent risk of reoperation (P = 0.12). There was no association between prior instrumentation and development of adjacent level stenosis requiring reoperation (P = 0.473).
CONCLUSIONS: Many patients with spinal stenosis undergo instrumentation because of instability. Most patients in this study underwent reoperation at the same level, and the most common pathology was spinal stenosis. The risk of reoperation was lower in older patients (≥65 years old). Although there was a trend that the risk of reoperation was higher among patients with prior instrumentation, it did not reach statistical significance. In this study, there was no association between prior instrumentation and adjacent level stenosis requiring reoperation. These findings need to be evaluated further in randomized trials.
Authors:
Vijayakumar Javalkar; Raul Cardenas; Tamir A Tawfik; Imtiaz R Khan; Papireddy Bollam; Anirban Deep Banerjee; Anil Nanda
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  World neurosurgery     Volume:  75     ISSN:  1878-8750     ISO Abbreviation:  World Neurosurg     Publication Date:    2011 May-Jun
Date Detail:
Created Date:  2011-06-27     Completed Date:  2011-08-30     Revised Date:  2011-09-26    
Medline Journal Info:
Nlm Unique ID:  101528275     Medline TA:  World Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  737-42     Citation Subset:  IM    
Copyright Information:
Published by Elsevier Inc.
Affiliation:
Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Aging / physiology
Bone Screws
Cohort Studies
Decompression, Surgical*
Device Removal
Female
Humans
Internal Fixators
Kaplan-Meier Estimate
Magnetic Resonance Imaging
Male
Middle Aged
Myelography
Orthopedic Procedures*
Patient Selection
Postoperative Complications / epidemiology,  surgery
Reoperation*
Retrospective Studies
Risk Factors
Spinal Stenosis / surgery*
Survival Analysis
Tomography, X-Ray Computed
Comments/Corrections
Comment In:
World Neurosurg. 2011 Jul-Aug;76(1-2):51-3   [PMID:  21839943 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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