Introduction: 5-14% of patients undergo revision discectomy for recurrent herniation and symptoms. No studies have quantified quality of life outcomes following primary versus revision discectomy.
Methods: A retrospective review of all patients who underwent a primary versus revision discectomy between January 2008 and December 2011 at a single tertiary-care institution was performed. Of the latter cohort, we identified those that required a second revision discectomy procedure. Patient QOL measures were recorded pre- and postoperatively. QOL measures included, EQ-5D and Quality Adjusted Life Year (QALY), Patient Health Questionnaire-9 (PHQ-9), and Pain and Disability Questionnaire (PDQ). Cohorts were compared using independent sample t-tests and Fisher’s exact tests for continuous and categorical variables. Multivariable logistic regression was performed to adjust for confounding.
Results: 196 patients were identified (116 for primary discectomy and 80 for revision discectomy) with average follow-up of 150 days. There were no preoperative QOL differences between groups. Postoperatively, both groups had significant improvements in all QOL measures. For QALY, the primary discectomy group improved by 0.25 points (p<0.001) and the revision discectomy group improved by 0.18 points (p<0.001). A significantly greater percentage of patients showed improvement in QALY for the primary discectomy group (76% vs. 59%, p=0.02), and improvement that exceeded the MCID (62% vs. 45%, p=0.03). Of the patients that underwent a revision discectomy, 14 (17.5%) had yet another recurrent herniation (3rd herniation). Four patients (5%) chose to undergo a 2nd revision discectomy and the other 10 (12.5%) underwent conservative management. Those that underwent a 2nd revision discectomy had worsening QOL in all questionnaires.
Conclusions: Quality of life, pain and disability, and psychosocial outcomes improve following both primary and revision discectomy, but that the improvement is diminished following revision discectomy.
Patient Care: Surgeons are frequently unsure how to treat recurrent disc herniations (either first or second re-herniation). By understanding the quality of life impact of these revision discectomies, the surgeon can better select the most appropriate surgical procedure, as well as prepare the patient for what to expect postoperatively.
Learning Objectives: To understand the quality of life outcomes following primary discectomy versus 1st time revision discectomy versus second time revision discectomy.