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



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.


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.


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).


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.


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



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



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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

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