Introduction: The objective of this study is to determine clinical and surgical outcomes following first-time lumbar laminectomy.
Methods: We retrospectively reviewed medical records of all patients who underwent first-time, bilateral, 1-3 level laminectomy for degenerative lumbar disease. Patients with discectomy, complete facetectomy, and fusion were excluded. Incident rates (IR) were expressed as a function of person-time and then converted to an annualized reoperation rate.
Results: Five hundred patients who met our selection criteria were followed for an average of 46.79 months. In comparing the number of patients with preoperative versus postoperative symptoms, improvements were reported with back pain (57.40% vs 25.40%, p<0.001), neurogenic claudication (45.40% to 7.00%, p<0.001), radiculopathy (32.80% vs 13.60%, p<0.001), weakness (18.20% vs 7.40%, p<0.001), and sensory deficits (6.20% to 7.80%, p<0.001). Of the 500 laminectomy cases, 72 patients (14.40%) required reoperation for progression of degenerative disease over a mean of 3.40 years. The annualized reoperation rate was 4.60% [IR=4.6 reoperations per 100 person-years]. The most common clinically symptomatic indication for reoperation was back pain (54.17%) followed by radiculopathy (47.22%), weakness (18.06%), sensory deficit (15.28%), and neurogenic claudication (19.44%). The relative risk of reoperation in patients with postoperative back pain was 6.14 times higher than those without postoperative back pain (p<0.001). Of the 72 patients undergoing first-time reoperation, 79.17% underwent laminectomy, 44.44% posterolateral fusion, and 8.33% interbody placement. Upon cumulating all-time reoperations, the lifetime risk of a fusion was 8.0% following a lumbar laminectomy.
Conclusions: In the largest Western cohort series on lumbar laminectomy, patients experienced statistically significant improvements in back pain, neurogenic claudication, radiculopathy, motor weakness, and sensory deficit. Following a first-time laminectomy, the overall reoperation rate was 14.4% over a mean of 3.40 years, and the annualized reoperation rate was less than 5%. The lifetime risk of a fusion was 8.0%.
Patient Care: This study outlines the outcomes of patients undergoing a first-time, bilateral, 1-3 level lumbar laminectomy
Learning Objectives: 1. Following a first-time laminectomy, the overall reoperation rate was 14.4% over a mean of 3.40 years.
2. Following a first-time laminectomy, the annualized reoperation rate was less than 5%.
3. Following a first-time laminectomy, the lifetime risk of a fusion was 8.0%.