110 Arthrodesis vs Revision Discectomy for Recurrent Lumbar Disc Herniation: Patient-Reported Outcomes in 417 Patients From the N2QOD Registry.

INTRODUCTION: Comparative effectiveness of spinal fusion vs revision discectomy for lumbar recurrent disc herniation (RDH) has yet to be evaluated. By analyzing nationwide longitudinal patient-reported outcomes spine registry, we characterized utilization of arthrodesis for lumbar RDH and analyzed its associated outcomes vs discectomy alone.

METHODS: N2QOD registry prospectively enrolls spine surgery patients via representative sampling and prospectively collects measures of surgical safety and patient-reported outcomes for 1 year postoperatively. All lumbar surgery cases performed for same-level, same-side RDH without listhesis or instability were queried to compare outcomes between revision discectomy with arthrodesis vs without arthrodesis.

RESULTS: Four hundred seventeen RDH patients were enrolled with 1-year follow-up (135 [32%] arthrodesis, 282 [68%] discectomy). Patients treated with arthrodesis more frequently presented with back- vs leg-dominant symptoms, had greater back pain scores (VAS: 7 vs 6), and more frequently had symptoms for >3 months. High ASA grade and unemployment were greater in the arthrodesis cohort. Baseline Oswestry Disability Index (ODI), quality-adjusted life-year (QALY), and all other variables were similar. Length of surgery, blood loss, length of hospitalization, perioperative complications (3.8% vs 1.4%, P = .13), and need for in-patient rehabilitation were greater in the arthrodesis vs discectomy cohort. Fusion was associated with delayed return to work. In the first 3 months after surgery, reoperation was lower in the arthrodesis cohort (1.5% vs 3.7%, P = .20), incidence of 1-year reoperation was similar (9.7% vs 8.3%, P = .73). Significant and equivalent improvements in pain, disability, and QALY were reported 1 year after surgery in both cohorts. In subset analysis of RDH patients with back-dominant symptoms and baseline BP-VAS = 8, revision discectomy alone provided equivalent health benefit in comparison with arthrodesis.

CONCLUSION: Arthrodesis is associated with greater healthcare utilization and morbidity, but also with a trend of reduced 3 month re-operation with equivalent 1-year outcomes. Revision discectomy alone may be most efficient treatment option for patients experiencing recurrent disc herniation without listhesis or instability, particularly in those without back dominant symptoms.