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Reoperation of decompression alone or decompression plus fusion surgeries for degenerative lumbar diseases: a systematic review

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Abstract

Purpose

The objective of this paper was to compare the reoperation rates, timing and causes between decompression alone and decompression plus fusion surgeries for degenerative lumbar diseases through a systematic review of the published data.

Methods

A search of the literature was conducted on PubMed/MEDLINE, EMBASE and the Cochrane Collaboration Library. Reports that included reoperations after decompression alone and/or decompression plus fusion surgeries were selected using designed eligibility criteria. Comparative analysis of reoperation rates, timing and causes between the two surgeries was conducted.

Results

Thirty-two retrospective and three prospective studies were selected from 6401 papers of the literature search. The analysis of data reported in these studies revealed that both surgeries resulted in similar reoperation rates after the primary surgery. However, majority of reoperations following the fusion surgeries were due to adjacent-segment diseases, and following the decompression alone surgeries were due to the same-segment diseases. Reoperation rates were not found to decrease in patients operated more recently than those operated in early times.

Conclusions

Reoperation rates were similar following decompression alone or plus fusion surgeries for degenerative lumbar diseases. However, different underlying major causes exist between the two surgeries. There is no evidence showing that the reoperation rate has a trend to decline with newer surgical techniques used. The exact mechanisms of reoperation after both surgeries are still unclear. Further researches are necessary to investigate the mechanisms of reoperation for improvement of surgical techniques that aim to delay or prevent reoperation after lumbar surgery.

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Funding

This research was partially supported by National Institute of Health (R21AR057989).

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Authors and Affiliations

  1. Orthopaedic Bioengineering Research Center, Department of Orthopaedic Surgery, Newton-Wellesley Hospital and Harvard Medical School, 159 Wells Avenue, Newton, MA, 02459, USA

    Zhao Lang, **g-Sheng Li, Felix Yang, Yan Yu, Kamran Khan, Louis G. Jenis, Thomas D. Cha & Guoan Li

  2. Department of Spine Surgery, Bei**g Jishuitan Hospital, Fourth Clinical Medical College of Peking University, Bei**g, 100035, China

    Zhao Lang

  3. College of Health and Rehabilitation Sciences, Sargent College, Boston University, Boston, MA, 02215, USA

    **g-Sheng Li

  4. Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, 2000065, China

    Yan Yu

  5. Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA

    Thomas D. Cha

  6. Department of Orthopaedic Surgery, Brigham and Women’s Hospital/Harvard Medical School, Boston, MA, 02115, USA

    James D. Kang

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  1. Zhao Lang
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  2. **g-Sheng Li
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  9. Guoan Li
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Correspondence to Guoan Li.

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Thomas D. Cha has received research grants from North American Spine Society and Gordon and Betty Moore Foundation. Other authors declare that they have no conflict of interest.

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Lang, Z., Li, JS., Yang, F. et al. Reoperation of decompression alone or decompression plus fusion surgeries for degenerative lumbar diseases: a systematic review. Eur Spine J 28, 1371–1385 (2019). https://doi.org/10.1007/s00586-018-5681-2

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  • DOI: https://doi.org/10.1007/s00586-018-5681-2

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