Advertisement

European Spine Journal

, Volume 25, Issue 8, pp 2553–2562 | Cite as

Influence of previous surgery on patient-rated outcome after surgery for degenerative disorders of the lumbar spine

  • Pascal Zehnder
  • Emin Aghayev
  • Tamas F. Fekete
  • Daniel Haschtmann
  • Tim Pigott
  • Anne F. Mannion
Original Article

Abstract

Purpose

Few studies have used multivariate models to quantify the effect of multiple previous spine surgeries on patient-oriented outcome after spine surgery. This study sought to quantify the effect of prior spine surgery on 12-month postoperative outcomes in patients undergoing surgery for different degenerative disorders of the lumbar spine.

Methods

The study included 4940 patients with lumbar degenerative disease documented in the Spine Tango Registry of EUROSPINE, the Spine Society of Europe, from 2004 to 2015. Preoperatively and 12 months postoperatively, patients completed the multidimensional Core Outcome Measures Index (COMI; 0–10 scale). Patients’ medical history and surgical details were recorded using the Spine Tango Surgery 2006 and 2011 forms. Multiple linear regression models were used to investigate the relationship between the number of previous surgeries and the 12-month postoperative COMI score, controlling for the baseline COMI score and other potential confounders.

Results

In the adjusted model including all cases, the 12-month COMI score showed a 0.37-point worse value [95 % confidence intervals (95 % CI) 0.29–0.45; p < 0.001] for each additional prior spine surgery. In the subgroup of patients with lumbar disc herniation, the corresponding effect was 0.52 points (95 % CI 0.27–0.77; p < 0.001) and in lumbar degenerative spondylolisthesis, 0.40 points (95 % CI 0.17–0.64; p = 0.001).

Conclusions

We were able to demonstrate a clear “dose–response” effect for previous surgery: the greater the number of prior spine surgeries, the systematically worse the outcome at 12 months’ follow-up. The results of this study can be used when considering or consenting a patient for further surgery, to better inform the patient of the likely outcome and to set realistic expectations.

Keywords

Previous surgery Degenerative disorders of the lumbar spine Patient-rated outcome Spine Tango COMI 

Notes

Acknowledgments

The study was funded by the Schulthess Klinik Research funds, the Mäxi Foundation (Switzerland), and Eurospine’s Spine Tango. We are grateful to Malgorzata Roos, Dept Biostatistics, University of Zürich, for her advice and assistance in conducting the statistical analysis. The participants of the Spine Tango Registry are acknowledged for their contribution of data. The data of the following centers were used in the present study (in alphabetic order of country, city, hospital and department): Dept. Orthopedic Surgery, Saint Pierre Clinic, Ottignies (Belgium); Dept. of Orthopaedic Surgery, University Hospital, St. Luc (Belgium); Dept. of Neurosurgery, Bethesda Hospital, Basel (Switzerland); Dept. of Orthopedic Surgery, Salem Hospital, Bern (Switzerland); Spine Center, Schulthess Clinic, Zurich (Switzerland); Dept. of Neurosurgery, The Walton Centre, Liverpool (UK).

Compliance with ethical standards

Conflict of interest

None.

References

  1. 1.
    Martin BI, Mirza SK, Comstock BA, Gray DT, Kreuter W, Deyo RA (2007) Reoperation rates following lumbar spine surgery and the influence of spinal fusion procedures. Spine (Phila Pa 1976) 32:382–387. doi: 10.1097/01.brs.0000254104.55716.46 CrossRefGoogle Scholar
  2. 2.
    Hu RW, Jaglal S, Axcell T, Anderson G (1997) A population-based study of reoperations after back surgery. Spine (Phila Pa 1976) 22:2265–2270 (discussion 2271) CrossRefGoogle Scholar
  3. 3.
    Fritzell P, Knutsson B, Sanden B, Stromqvist B, Hagg O (2014) Recurrent versus primary lumbar disc herniation surgery: patient-reported outcomes in the Swedish Spine Register Swespine. Clin Orthop Relat Res. doi: 10.1007/s11999-014-3596-8 PubMedCentralGoogle Scholar
  4. 4.
    Kim CH, Chung CK, Park CS, Choi B, Kim MJ, Park BJ (2013) Reoperation rate after surgery for lumbar herniated intervertebral disc disease: nationwide cohort study. Spine (Phila Pa 1976) 38:581–590. doi: 10.1097/BRS.0b013e318274f9a7 CrossRefGoogle Scholar
  5. 5.
    Katz JN, Lipson SJ, Chang LC, Levine SA, Fossel AH, Liang MH (1996) Seven- to 10-year outcome of decompressive surgery for degenerative lumbar spinal stenosis. Spine (Phila Pa 1976) 21:92–98CrossRefGoogle Scholar
  6. 6.
    Herno A, Airaksinen O, Saari T, Sihvonen T (1995) Surgical results of lumbar spinal stenosis. A comparison of patients with or without previous back surgery. Spine (Phila Pa 1976) 20:964–969CrossRefGoogle Scholar
  7. 7.
    Lad SP, Babu R, Ugiliweneza B, Patil CG, Boakye M (2014) Surgery for spinal stenosis: long-term reoperation rates, health care cost, and impact of instrumentation. Spine (Phila Pa 1976) 39:978–987. doi: 10.1097/BRS.0000000000000314 CrossRefGoogle Scholar
  8. 8.
    Nork SE, Hu SS, Workman KL, Glazer PA, Bradford DS (1999) Patient outcomes after decompression and instrumented posterior spinal fusion for degenerative spondylolisthesis. Spine (Phila Pa 1976) 24:561–569CrossRefGoogle Scholar
  9. 9.
    Malter AD, McNeney B, Loeser JD, Deyo RA (1998) 5-year reoperation rates after different types of lumbar spine surgery. Spine (Phila Pa 1976) 23:814–820CrossRefGoogle Scholar
  10. 10.
    Osterman H, Sund R, Seitsalo S, Keskimaki I (2003) Risk of multiple reoperations after lumbar discectomy: a population-based study. Spine (Phila Pa 1976) 28:621–627. doi: 10.1097/01.BRS.0000049908.15854.ED Google Scholar
  11. 11.
    Deyo RA, Battie M, Beurskens AJ, Bombardier C, Croft P, Koes B, Malmivaara A, Roland M, Von Korff M, Waddell G (1998) Outcome measures for low back pain research. A proposal for standardized use. Spine (Phila Pa 1976) 23:2003–2013CrossRefGoogle Scholar
  12. 12.
    Waddell G, Kummel EG, Lotto WN, Graham JD, Hall H, McCulloch JA (1979) Failed lumbar disc surgery and repeat surgery following industrial injuries. J Bone Joint Surg Am 61:201–207PubMedGoogle Scholar
  13. 13.
    Vik A, Zwart JA, Hulleberg G, Nygaard OP (2001) Eight year outcome after surgery for lumbar disc herniation: a comparison of reoperated and not reoperated patients. Acta Neurochir (Wien) 143:607–610 (discussion 610-611) CrossRefGoogle Scholar
  14. 14.
    Dai LY, Zhou Q, Yao WF, Shen L (2005) Recurrent lumbar disc herniation after discectomy: outcome of repeat discectomy. Surg Neurol 64:226–231. doi: 10.1016/j.surneu.2004.11.003 (discussion 231) CrossRefPubMedGoogle Scholar
  15. 15.
    Skaf G, Bouclaous C, Alaraj A, Chamoun R (2005) Clinical outcome of surgical treatment of failed back surgery syndrome. Surg Neurol 64:483–488. doi: 10.1016/j.surneu.2005.04.009 (discussion 488-489) CrossRefPubMedGoogle Scholar
  16. 16.
    Sobottke R, Herren C, Siewe J, Mannion AF, Roder C, Aghayev E (2015) Predictors of improvement in quality of life and pain relief in lumbar spinal stenosis relative to patient age: a study based on the Spine Tango registry. Eur Spine J. doi: 10.1007/s00586-015-4078-8 Google Scholar
  17. 17.
    Mannion AF, Porchet F, Kleinstuck FS, Lattig F, Jeszenszky D, Bartanusz V, Dvorak J, Grob D (2009) The quality of spine surgery from the patient’s perspective. Part 1: The Core Outcome Measures Index in clinical practice. Eur Spine J 18(Suppl 3):367–373. doi: 10.1007/s00586-009-0942-8 CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Röder C (2015) EUROSPINE Spine Tango. EUROSPINE. http://www.eurospine.org/spine-tango.htm. Accessed 02.07.2015
  19. 19.
    Mannion AF, Porchet F, Kleinstuck FS, Lattig F, Jeszenszky D, Bartanusz V, Dvorak J, Grob D (2009) The quality of spine surgery from the patient’s perspective: Part 2. Minimal clinically important difference for improvement and deterioration as measured with the Core Outcome Measures Index. Eur Spine J 18(Suppl 3):374–379. doi: 10.1007/s00586-009-0931-y CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Monticone M, Ferrante S, Maggioni S, Grenat G, Checchia GA, Testa M, Teli MG, Mannion AF (2014) Reliability, validity and responsiveness of the cross-culturally adapted Italian version of the Core Outcome Measures Index (COMI) for the neck. Eur Spine J 23:863–872. doi: 10.1007/s00586-013-3092-y CrossRefPubMedGoogle Scholar
  21. 21.
    Fankhauser CD, Mutter U, Aghayev E, Mannion AF (2012) Validity and responsiveness of the Core Outcome Measures Index (COMI) for the neck. Eur Spine J 21:101–114. doi: 10.1007/s00586-011-1921-4 CrossRefPubMedGoogle Scholar
  22. 22.
    Genevay S, Marty M, Courvoisier DS, Foltz V, Mahieu G, Demoulin C, Fontana AG, Norberg M, de Goumoens P, Cedraschi C, Rozenberg S, Section Rachisde la Societe Francaise de Rhumatologie (2014) Validity of the French version of the Core Outcome Measures Index for low back pain patients: a prospective cohort study. Eur Spine J 23:2097–2104. doi: 10.1007/s00586-014-3325-8 CrossRefPubMedGoogle Scholar
  23. 23.
    Mannion AF, Fekete TF, Porchet F, Haschtmann D, Jeszenszky D, Kleinstuck FS (2014) The influence of comorbidity on the risks and benefits of spine surgery for degenerative lumbar disorders. Eur Spine J 23(Suppl 1):S66–S71. doi: 10.1007/s00586-014-3189-y CrossRefPubMedGoogle Scholar
  24. 24.
    Seicean A, Alan N, Seicean S, Worwag M, Neuhauser D, Benzel EC, Weil RJ (2014) Impact of increased body mass index on outcomes of elective spinal surgery. Spine (Phila Pa 1976) 39:1520–1530. doi: 10.1097/brs.0000000000000435 CrossRefGoogle Scholar
  25. 25.
    Auffinger B, Lam S, Kraninger J, Shen J, Roitberg BZ (2014) The impact of obesity on surgeon ratings and patient-reported outcome measures after degenerative cervical spine disease surgery. World Neurosurg 82:e345–e352. doi: 10.1016/j.wneu.2013.09.053 CrossRefPubMedGoogle Scholar
  26. 26.
    Knutsson B, Michaelsson K, Sanden B (2013) Obesity is associated with inferior results after surgery for lumbar spinal stenosis: a study of 2633 patients from the Swedish Spine Register. Spine (Phila Pa 1976) 38:435–441. doi: 10.1097/BRS.0b013e318270b243 CrossRefGoogle Scholar
  27. 27.
    Hajihosseinali M, Arjmand N, Shirazi-Adl A (2015) Effect of body weight on spinal loads in various activities: a personalized biomechanical modeling approach. J Biomech 48:276–282. doi: 10.1016/j.jbiomech.2014.11.033 CrossRefPubMedGoogle Scholar
  28. 28.
    Gulati S, Nordseth T, Nerland US, Gulati M, Weber C, Giannadakis C, Nygaard OP, Solberg TK, Solheim O, Jakola AS (2015) Does daily tobacco smoking affect outcomes after microdecompression for degenerative central lumbar spinal stenosis? A multicenter observational registry-based study. Acta Neurochir (Wien) 157:1157–1164. doi: 10.1007/s00701-015-2437-1 CrossRefGoogle Scholar
  29. 29.
    Severn A (2007) Anaesthesia and the preparation and management of elderly patients undergoing surgery. Eur J Cancer 43:2231–2234. doi: 10.1016/j.ejca.2007.08.013 CrossRefPubMedGoogle Scholar
  30. 30.
    Sobottke R, Aghayev E, Roder C, Eysel P, Delank SK, Zweig T (2012) Predictors of surgical, general and follow-up complications in lumbar spinal stenosis relative to patient age as emerged from the Spine Tango Registry. Eur Spine J 21:411–417. doi: 10.1007/s00586-011-2016-y CrossRefPubMedGoogle Scholar
  31. 31.
    Ulrich NH, Kleinstuck F, Woernle CM, Antoniadis A, Winklhofer S, Burgstaller JM, Farshad M, Oberle J, Porchet F, Min K (2015) Clinical outcome in lumbar decompression surgery for spinal canal stenosis in the aged population: a prospective Swiss multicenter cohort study. Spine (Phila Pa 1976) 40:415–422. doi: 10.1097/brs.0000000000000765 CrossRefGoogle Scholar
  32. 32.
    Adogwa O, Parker SL, Shau DN, Mendenhall SK, Aaronson OS, Cheng JS, Devin CJ, McGirt MJ (2012) Preoperative Zung Depression Scale predicts outcome after revision lumbar surgery for adjacent segment disease, recurrent stenosis, and pseudarthrosis. Spine J 12:179–185. doi: 10.1016/j.spinee.2011.08.014 CrossRefPubMedGoogle Scholar
  33. 33.
    Cedraschi C, Marty M, Courvoisier DS, Foltz V, Mahieu G, Demoulin C, Gierasimowicz Fontana A, Norberg M, de Goumoens P, Rozenberg S, Genevay S (2015) Core Outcome Measure Index for low back patients: do we miss anxiety and depression? Eur Spine J. doi: 10.1007/s00586-015-3935-9 Google Scholar
  34. 34.
    Nerland US, Jakola AS, Giannadakis C, Solheim O, Weber C, Nygaard OP, Solberg TK, Gulati S (2015) The risk of getting worse: predictors of deterioration after decompressive surgery for lumbar spinal stenosis—a multicenter observational study. World Neurosurg. doi: 10.1016/j.wneu.2015.05.055 Google Scholar
  35. 35.
    Soroceanu A, Ching A, Abdu W, McGuire K (2012) Relationship between preoperative expectations, satisfaction, and functional outcomes in patients undergoing lumbar and cervical spine surgery: a multicenter study. Spine (Phila Pa 1976) 37:E103–E108. doi: 10.1097/BRS.0b013e3182245c1f CrossRefGoogle Scholar
  36. 36.
    Mannion AF, Junge A, Elfering A, Dvorak J, Porchet F, Grob D (2009) Great expectations: really the novel predictor of outcome after spinal surgery? Spine (Phila Pa 1976) 34:1590–1599. doi: 10.1097/BRS.0b013e31819fcd52 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Pascal Zehnder
    • 1
  • Emin Aghayev
    • 2
  • Tamas F. Fekete
    • 1
  • Daniel Haschtmann
    • 1
  • Tim Pigott
    • 3
  • Anne F. Mannion
    • 1
  1. 1.Spine Center, Schulthess KlinikZurichSwitzerland
  2. 2.Institute for Evaluative Research in MedicineUniversity of BernBernSwitzerland
  3. 3.Department of NeurosurgeryWalton Centre for Neurology and NeurosurgeryLiverpoolUK

Personalised recommendations