Durability of Lumbar Diskectomy: A Survivorship Analysis Based on Revision Surgery Rates
Bibliographic record
Abstract
INTRODUCTION: Durability of surgical treatment is important to patients, providers, and payers. Lumbar diskectomy is one of the most commonly performed spinal surgeries. Understanding the specific indications for revision surgery can help guide future research and quality improvement initiatives. METHODS: A multisurgeon, single-institution database was queried for revision surgery following a primary lumbar diskectomy (CPT = 63,030) from 2014 to 2018 with a minimum follow-up of 4 years (N = 1,133). The mean patient age was 44.93 years, levels decompressed was 1.08, mean body mass index was 30.45 kg·m -2 , mean American Society of Anesthesiologists (ASA) score was 2.33, length of stay was 0.44 days, and mean OR time was 115.41 minutes. Primary indication for revision surgery was collected through medical record analysis. RESULTS: A total of 185 of 1,133 patients (16%) underwent unplanned revision surgery during the study period. The most common indication for revision surgery was repeat decompression (N = 80, 7%) at a mean of 334.2 days postoperatively. The second most common indication was instability requiring fusion (N = 53, 5%) at a mean of 640.89 days postoperatively. Surgery for infection (N = 22, 1.9%) occurred at a mean of 37.77 days postoperatively. Other indications for revision surgery were less common and included: adjacent segment disease (N = 13, 1.1%) at a mean of 682.31 days postoperatively, durotomy repair (N = 13, 1.1%) at a mean of 26.77 days postoperatively, evacuation of hematoma/seroma (N = 4, 0.3%) at a mean of 6.75 days postoperatively. Binary logistic regression showed that age ( P = 0.368), number of surgical levels ( P = 0.694), and ASA grade ( P = 0.152) were not associated with revision surgery. The only factor associated with revision surgery was BMI ( P = 0.005; odds ratio: 1.042; 95% CI, 1.01-1.07). DISCUSSION: The results of this study show that lumbar diskectomy is a relatively durable procedure (84%) as currently indicated and performed in a large multisurgeon spine center. Early revision surgery (<90 days) for infection, hematoma/seroma, or durotomy repair is rare (3.3%). Late revision surgery (>90 days) for same segment pathology including recurrent stenosis with or without instability (12%) is much more common than adjacent segment disease (1.1%). These data can help guide clinicians and researchers in future quality improvement initiatives.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".