Kazuyoshi Kobayashi1, Kei Ando1, Fumihiko Kato2, Tokumi Kanemura3, Koji Sato4, Yudo Hachiya5, Yuji Matsubara6, Mitsuhiro Kamiya7, Yoshihito Sakai8, Hideki Yagi9, Ryuichi Shinjo10, Yoshihiro Nishida1, Naoki Ishiguro1, Shiro Imagama11. 1. Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan. 2. Department of Orthopaedic Surgery, Chubu Rosai Hospital, 1-10-6, Komei, Minato-ku, Nagoya, 455-8530, Japan. 3. Department of Orthopaedic Surgery, Konan Kousei Hospital, 137, Omatsubara, Takaya-cho, Konan, Aichi, 483-8704, Japan. 4. Department of Orthopaedic Surgery, Japanese Red Cross Nagoya Daini Hospital, 2-9, Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan. 5. Department of Orthopaedic Surgery, Hachiya Orthopaedic Hospital, 2-4, Suemoridori, Chikusa-ku, Nagoya, 464-0821, Japan. 6. Department of Orthopaedic Surgery, Kariya Toyota General Hospital, 15, Sumiyoshi-cho5, Kariyashi, Aichi, 448-8505, Japan. 7. Department of Orthopaedic Surgery, Aichi Medical University, 1-1, Iwasaku, Nagakute, Aichi, 480-1195, Japan. 8. Department of Orthopaedic Surgery, National Center for Geriatrics and Gerontology, 7-430, Morioka-cho, Obu, Aichi, 474-8511, Japan. 9. Department of Orthopaedic Surgery, Japanese Red Cross Nagoya Daiichi Hospital, 3-35, Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan. 10. Department of Orthopaedic Surgery, Anjo Kosei Hospital, 28, Higashi-Kohan, Anjo-cho, Anjo, Aichi, 446-8602, Japan. 11. Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan. imagama@med.nagoya-u.ac.jp.
Abstract
PURPOSE: Posterior lumbar interbody fusion (PLIF)/transforaminal lumbar interbody fusion (TLIF) can have complications that require reoperation. The goal of the study was to identify risk factors for reoperation within 2 years after PLIF/TLIF. METHODS: A retrospective analysis of a prospective multicenter database was performed for patients who underwent PLIF/TLIF. A total of 1363 patients (689 males and 674 females) were identified, with an average age of 65.9 years old. Comorbidities, perioperative ASA grade, and operative factors were compared between patients with and without reoperation. Risk factors for reoperation were identified in multivariate logistic analysis. RESULTS: There were 38 reoperations within 2 years after PLIF/TLIF (2.8%). The original surgical procedures were open PLIF (n = 26), open TLIF (n = 10), and minimally invasive surgery (n = 2). Reoperation was due to adjacent segment degeneration (ASD) (n = 10), surgical site infection (SSI) (n = 9), screw misplacement (n = 6), postoperative epidural hematoma (n = 6), pseudoarthrosis (n = 4), and cage protrusion (n = 3). Number of levels fused and dural tear were significantly associated with reoperation. In analysis of complications requiring reoperation, SSI was related to diabetes mellitus and dural tear, and postoperative epidural hematoma was related to fusion of two or more levels, EBL, and operation time. In multivariate logistic regression, fusion of two or more levels (HR 2.19) was significantly associated with reoperation. CONCLUSION: Surgical invasiveness, as reflected by number of fused levels, operation time, EBL and dural tear, was associated with reoperation. Fusion of two or more levels is a strong risk factor for reoperation within 2 years after initial PLIF/TLIF. These slides can be retrieved under Electronic Supplementary Material.
PURPOSE: Posterior lumbar interbody fusion (PLIF)/transforaminal lumbar interbody fusion (TLIF) can have complications that require reoperation. The goal of the study was to identify risk factors for reoperation within 2 years after PLIF/TLIF. METHODS: A retrospective analysis of a prospective multicenter database was performed for patients who underwent PLIF/TLIF. A total of 1363 patients (689 males and 674 females) were identified, with an average age of 65.9 years old. Comorbidities, perioperative ASA grade, and operative factors were compared between patients with and without reoperation. Risk factors for reoperation were identified in multivariate logistic analysis. RESULTS: There were 38 reoperations within 2 years after PLIF/TLIF (2.8%). The original surgical procedures were open PLIF (n = 26), open TLIF (n = 10), and minimally invasive surgery (n = 2). Reoperation was due to adjacent segment degeneration (ASD) (n = 10), surgical site infection (SSI) (n = 9), screw misplacement (n = 6), postoperative epidural hematoma (n = 6), pseudoarthrosis (n = 4), and cage protrusion (n = 3). Number of levels fused and dural tear were significantly associated with reoperation. In analysis of complications requiring reoperation, SSI was related to diabetes mellitus and dural tear, and postoperative epidural hematoma was related to fusion of two or more levels, EBL, and operation time. In multivariate logistic regression, fusion of two or more levels (HR 2.19) was significantly associated with reoperation. CONCLUSION: Surgical invasiveness, as reflected by number of fused levels, operation time, EBL and dural tear, was associated with reoperation. Fusion of two or more levels is a strong risk factor for reoperation within 2 years after initial PLIF/TLIF. These slides can be retrieved under Electronic Supplementary Material.
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