Revision Surgery for Short Segment Fusion Influences Postoperative Low Back Pain and Lower Extremity Pain: A Retrospective Single-Center Study of Patient-Based Evaluation

• Main Authors: Takashi Hirai, Toshitaka Yoshii, Hiroyuki Inose, Tsuyoshi Yamada, Masato Yuasa, Shuta Ushio, Satoru Egawa, Keigo Hirai, Atsushi Okawa
• Format: Article
• Language: English
• Published: The Japanese Society for Spine Surgery and Related Research 2018-07-01
• Series: Spine Surgery and Related Research
• Subjects: lumbar spinal fusion; reoperation; adjacent segment disease; pain
• Online Access: https://www.jstage.jst.go.jp/article/ssrr/2/3/2_2017-0048/_pdf/-char/en

Introduction: Patients treated with revision surgery after lumbar decompression with fusion typically have persistent low back pain and lower extremity numbness compared with patients treated with only primary surgery. No well-designed study has investigated the persistence and degree of pain after revision surgery following instrumented operation. The purpose of this study is to compare residual pain among patients who underwent reoperation and those who underwent only primary surgery for lumbar degenerative disorder using patient-based evaluation. Methods: We reviewed 350 consecutive patients (143 men, 207 women, mean age 63 years) treated with primary lumbar instrumented surgery between October 2010 and February 2014 at our institution and followed up for 2 years postoperatively. Patients were categorized into three groups based on number of levels fused: 1-segment, 2-segment, and 3-segment fusion (1F, 2F, and 3F groups, respectively). We used the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and visual analog scales (VASs) for low back pain and lower extremity pain to evaluate pain intensity pre- and postoperatively. Results: Salvage surgery for late-phase complications was required in 5 cases (2.4%), 6 cases (11.3%), and 11 cases (12.1%) in the 1F, 2F, and 3F groups, respectively. In the 1F and 2F groups, patients treated with revision surgery had unsatisfactory improvement in the pain domain of JOABPEQ and VASs for low back pain and lower extremity pain compared with patients with only primary short fusion surgery. The 3F group showed no significant differences between patients who underwent reoperation and those who underwent only primary surgery. Conclusion: Low back pain and lower extremity pain often persist after revision surgery in patients treated with short fusion (2-segment) operation. We need to follow pain states in such patients.