Prognostic Factors Associated with Revision Operation of Spine (Second Review)

Kyu Yeol Lee; Sung Keun Sohn; Dong Sik Kang; Sung Won Lee

doi:10.4184/jkss.2004.11.3.161

Journal List > J Korean Soc Spine Surg > v.11(3) > 1035619

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Lee, Sohn, Kang, and Lee: Prognostic Factors Associated with Revision Operation of Spine (Second Review)

Original Article

Journal of Korean Spine Surg 2004;11(3):161-167.

Published online: 21 February 2004

DOI: https://doi.org/10.4184/jkss.2004.11.3.161

Prognostic Factors Associated with Revision Operation of Spine (Second Review)

Kyu Yeol Lee, M.D., Sung Keun Sohn, M.D., Dong Sik Kang, M.D., Sung Won Lee, M.D.

Department of Orthopedic Surgery, College of Medicine, Dong-A University, Busan, Korea

Address reprint requests to Kyu-Yeol Lee, M.D. Department of Orthopedic Surgery, College of Medicine, Dong-A University,3-1 Dongdaesin-Dong, Seo-Gu, Busan, 602-715, Korea Tel: 82-51-240-2867, Fax: 82-51-243-9764, E-mail: gylee@mail.donga.ac.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study design

Patients who had had a revision operation were classified according to their outcome

Objective

To review a consecutive series of patients who had had a revision operation on the lumbar spine and to determine which factors contributed to a successful outcome.

Summary of Literature Review

The longterm failure rates after the primary surgery on the spine have been reported to be as high as 30 %.

Materals and Methods

This study analyzed 57 patients who had had a revision operation on the lumbar spine between Sep-tember 1995 and December 2001, and had been followed for a minimum of two years and were available for analysis. All the patients had had a decompression and instrumented fusion except for two patients who had just undergone a bone graft. These patients were followed for an average of 39 months. There were 37 men and 20 women. The patients had undergone one or more surgical procedures and an average of 54 months had elapsed since the most recent operation. The average age at the time of the revision was 52 years. The outcome was considered to be successful if the patient had met the all three criteria (Ed note: What were the 3 criteria?). Several factors were evaluated using multiple regression (level of significance, P<0.05) to be determine which were related to a successful outcome.

Results

Statistical analysis revealed that the factors associated with a successful outcome were a younger age (p<0.02), fewer spinal levels of revision surgery (p<0.05), pain- free interval after a previous operation (p<0.01). No significant relationship was observed between the outcome and gender, the number of prior procedures, the spinal level operated on, the presence of preoperative neurological signs and the intervals between the previous surgery and the revision.

Conclus ion

These results suggest that the prognostic factors are useful for evaluating the successful outcome of revision surgery of the spine.

Keywords: Spine revision operation, Prognostic factors

REFERENCES

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Figures and Tables%

Fig. 1.

(A) Preoperative radiographs show previous discectomy state at L3-4, L4-5. (B), (C) Preoperative Magnetic Resonance images show HNP in L3-4, L4-5. (D) In revision operation, posterior decompression and posterolateral fusion of L3-4, 4-5 were done. End result was poor according to three criteria for successful outcome. So this case was included to failure group.

Table 1.

Three criteria for successful outcome (Modified Bernard criteria 1993)

1) return to ordinary activity

2) use of analgesics

3) subjective satisfaction of patient

Table 2.

Results of revision operation

	success	failure
Post. decompression with post. lat. fusion
same as previous op. level	24	8
extended op. level	14	5
extended op. level due to junctional instability	3	1
Just posterolateral fusion with bone graft	2

Table 3.

Relationship of patient and operative values with respect to the success or failure of the revision procedures

	Average value of Prevalence		Significance (P Value)
	success group (N=5)	failure group (N=18)	Significance (P Value)
Previous op.
Interval between previous op. and revision op. (months)	32.0	40.2	^*NS
No. of op. level	1.5	2.0	NS
Pain-free interval postop.(months)	17.5	4.2	<0.05
Revision op.
No. of op. level	1.8	2.3	<0.02
Symptoms and signs
Analog pain rating (points) back	6.7	7.4	NS
lower extremity	6.7	7.2	NS
Neurologic deficit	27	7	NS
Patient data
Age at revision (yrs)	49.3	56.5	<0.03
Male gender	28	7	NS
No. of previous operations	1.1	1.2	NS

^∗ Non-specific

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