Patient-Reported Outcomes Decline After Second Revision Lumbar Fusion: A Retrospective Cohort Study.

Abstract

While lumbar fusion revision is associated with inferior outcomes compared to primary surgery, the impact of undergoing multiple revisions remains unclear. To evaluate surgical and patient-reported outcomes (PROMs) after primary, first revision, and second revision lumbar fusion, and to identify characteristics associated with multiple revisions. Retrospective cohort study at a single academic center (2011-2022). 747 patients underwent lumbar fusion: 554 had no revision, 153 underwent one revision, and 40 underwent ≥2 revisions. Surgical characteristics and PROMs including Oswestry Disability Index (ODI), Visual Analog Scale for back pain (VAS-back), Visual Analog Scale for leg pain (VAS-leg), 12-Item Short Form Survey (SF-12) Physical Component Summary (PCS) and Mental Component Summary (MCS), assessed preoperatively and at 3 months and 1 year postoperatively. Patients were stratified by number of surgeries. Delta PROM scores were calculated. Comparisons were made using Analysis of Variance (ANOVA) or Kruskal-Wallis tests. Patients undergoing revision were more often male (67.9 versus 45.5%, P < 0.01) and had higher Charlson Comorbidity Index (CCI) (1.84 versus 0.88, P < 0.001). Those with ≥ 2 revisions had more levels fused (3.05 versus 2.26, P = 0.040) and longer time from index surgery (47.1 versus 31.3 months, P = 0.002). PROMs declined with each revision. At 1 year, ODI scores were 23.2 (no revision), 35.4 (1st revision), and 38.1 (2nd revision) (P < 0.001). PCS-12 delta at 3 months was +4.21, -0.60, and -9.49, respectively (P < 0.001). A single revision may yield clinical improvement, but outcomes significantly decline after a second revision. Patients should be counseled on the limited benefit and higher risk of repeated lumbar fusion.