# A Prospective Observational Cohort Study to Analyze the Etiology of Revision Lumbar Spine Surgery at a Tertiary Care Spine Institute

## TL;DR

This study examines why patients need repeat lumbar spine surgery and finds that early revisions are often due to incomplete decompression or overlooked stenosis.

## Contribution

The study provides new insights into the causes of revision lumbar spine surgery and emphasizes the importance of thorough initial decompression.

## Key findings

- Early revisions (within two years) were often due to fusion procedures and overlooked stenosis.
- Late revisions (after five years) were more common after non-fusion procedures.
- Patients showed significant improvement in pain and function six months post-revision.

## Abstract

Introduction

Revision lumbar spine surgery is an increasing challenge, often necessitated by adjacent segment disease (ASD), recurrent stenosis, or implant-related complications. This study aimed to analyze the etiology and short-term outcomes of revision lumbar surgeries at a tertiary spine center.

Materials and methods

A prospective observational study was conducted at our institute, including all revision lumbar surgeries performed during the defined study period. Data collected included patient demographics, details of the index surgery, presenting complaints, indications for revision, characteristics of the revision procedure, and six-month postoperative outcomes (Visual Analogue Score (VAS) and Oswestry Disability Index (ODI)).

Results

A total of 103 revision surgeries (mean age 58.3 years; 54 females, 49 males) were included. Those in Group A were revised within two years (n=50, 49%); Group B were revised between two to five years (n=25, 24%); and Group C were revised more than five years after the index surgery (n=28, 27%). In Group A, revisions were predominantly in patients who had fusion procedures in the first surgery. In contrast, Group C had more patients whose index procedure was non-fusion. Analysis of the preoperative radiographs of previous surgeries revealed overlooked ASD, foraminal stenosis, and inadequately decompressed stenotic segments. Statistically significant improvement in pain and functional outcomes was noted at the six-month follow-up.

Conclusion

Prevention of early revision lumbar surgery requires adequate decompression during the primary procedure, identification and prophylactic treatment of partially stenotic adjacent levels, and recognition and decompression of the foraminal stenosis.