Independent Predictors of Revision Lumbar Fusion Outcomes and the Impact of Spine Surgeon Variability: Does It Matter Whether the Primary Surgeon Revises?

Thiago Scharth Montenegro; Akash Singh; Christopher Elia; Caio M Matias; Glenn A Gonzalez; Fadi Al Saiegh; Lucas Philipp; Ellina Hattar; Kevin Hines; Umma Fatema; Sara Thalheimer; Chengyuan Wu; Srinivas K Prasad; Jack Jallo; Joshua E Heller; Ashwini Sharan; James Harrop

doi:10.1093/neuros/nyab300

Independent Predictors of Revision Lumbar Fusion Outcomes and the Impact of Spine Surgeon Variability: Does It Matter Whether the Primary Surgeon Revises?

Neurosurgery. 2021 Oct 13;89(5):836-843. doi: 10.1093/neuros/nyab300.

Authors

Thiago Scharth Montenegro¹, Akash Singh¹, Christopher Elia¹, Caio M Matias¹, Glenn A Gonzalez¹, Fadi Al Saiegh¹, Lucas Philipp¹, Ellina Hattar¹, Kevin Hines¹, Umma Fatema¹, Sara Thalheimer¹, Chengyuan Wu¹, Srinivas K Prasad¹, Jack Jallo¹, Joshua E Heller¹, Ashwini Sharan¹, James Harrop¹

Affiliation

¹ Jefferson Hospital for Neuroscience, Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.

PMID: 34392365
DOI: 10.1093/neuros/nyab300

Abstract

Background: There is a paucity of information regarding treatment strategies and variables affecting outcomes of revision lumbar fusions.

Objective: To evaluate the influence of primary vs different surgeon on functional outcomes of revisions.

Methods: All elective lumbar fusion revisions, March 2018 to August 2019, were retrospectively categorized as performed by the same or different surgeon who performed the primary surgery. Oswestry Disability Index (ODI) and clinical variables were collected. Multiple logistic regression identified multivariable-adjusted odds ratio (OR) of independent variables analyzed.

Results: Of the 130 cases, 117 (90%) had complete data. There was a slight difference in age in the same (median: 59; interquartile range [IQR], 54-66) and different surgeon (median: 67; IQR, 56-72) groups (P = .02); all other demographic variables were not significantly different (P > .05). Revision surgery with a different surgeon had an ODI improvement (median: 8; IQR, 2-14) greater than revisions performed by the same surgeon (median: 1.5; IQR, -3 to 10) (P < .01). Revisions who achieved minimum clinically important difference (MCID) performed by different surgeon (59.7%) were also significantly greater than the ones performed by the same surgeon (40%) (P = .042). Multivariate analysis demonstrated that a different surgeon revising (OR, 2.37; [CI]: 1.007-5.575, P = .04) was an independent predictor of MCID achievement, each additional 2 years beyond the last surgery conferred a 2.38 ([CI]: 1.36-4.14, P < .01) times greater odds of MCID achievement, and the anterior lumbar interbody fusion approach decreased the chance of achieving MCID (OR, 0.19; [CI]: 0.04-0.861, P = .03).

Conclusion: All revision lumbar spinal fusion approaches may not achieve the same outcomes. This analysis suggests that revision surgeries may have better outcomes when performed by a different surgeon.

Keywords: Different spine surgeon; Functional outcomes; Lumbar spine fusion; Patient-reported outcome measure; Revision spine surgery.

MeSH terms

Humans
Lumbar Vertebrae / surgery
Retrospective Studies
Spinal Fusion*
Surgeons*
Treatment Outcome