• Matthew J McGirt, Scott L Parker, Domagoj Coric, Paul Keetae Kim, Kevin Scott Cahill, Clinton J Devin, and Anthony L Asher.
• Neurosurgery. 2015 Aug 1;62 Suppl 1:200.

IntroductionComparative 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.MethodsN2QOD 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.ResultsFour 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.ConclusionArthrodesis 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.

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