Patient-reported outcomes decline after second revision lumbar fusion: a retrospective cohort study.
Publication/Presentation Date
8-1-2026
Abstract
BACKGROUND CONTEXT: While lumbar fusion revision is associated with inferior outcomes compared to primary surgery, the impact of undergoing multiple revisions remains unclear.
PURPOSE: To evaluate surgical and patient-reported outcomes measures (PROMs) after primary, first revision, and second revision lumbar fusion, and to identify characteristics associated with multiple revisions.
STUDY DESIGN/SETTING: Retrospective cohort study at a single academic center (2011-2022).
PATIENT SAMPLE: A total of 747 patients underwent lumbar fusion: 554 had no revision, 153 underwent 1 revision, and 40 underwent ≥2 revisions.
OUTCOME MEASURES: Surgical characteristics and PROMs, including Oswestry Disability Index, visual analog scale for back pain, visual analog scale for leg pain, 12-Item Short Form Survey (SF-12) Physical Component Summary and Mental Component Summary, assessed preoperatively and at 3 months and 1 year postoperatively.
METHODS: Patients were stratified by number of surgeries. Delta PROM scores were calculated. Comparisons were made using analysis of variance (ANOVA) or Kruskal-Wallis tests.
RESULTS: Patients undergoing revision were more often male (67.9 vs 45.5%, p< .01) and had higher Charlson Comorbidity Index (1.84 vs 0.88, p< .001). Those with ≥2 revisions had more levels fused (3.05 vs 2.26, p=.040) and longer time from index surgery (47.1 vs 31.3 months, p=.002). PROMs declined with each revision. At 1 year, Oswestry Disability Index scores were 23.2 (no revision), 35.4 (1st revision), and 38.1 (2nd revision) (p< .001). Physical Component Summary-12 delta at 3 months was +4.21, -0.60, and -9.49, respectively (p< .001).
CONCLUSIONS: 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.
Volume
26
Issue
8
First Page
1529
Last Page
1537
ISSN
1878-1632
Published In/Presented At
Ng, M. K., Baidya, J., Mathew, J., Dalton, J., Baek, G., Lee, Y., Green, W., Farooqi, A., Giakas, A., Alfonsi, S., Narayanan, R., Opara, O., Meade, M., Lee, Y., Ezeonu, T., McCurdy, M., Reddy, Y., McCormick, C., Kurd, M. F., Wilt, Z., … Schroeder, G. D. (2026). Patient-reported outcomes decline after second revision lumbar fusion: a retrospective cohort study. The spine journal : official journal of the North American Spine Society, 26(8), 1529–1537. https://doi.org/10.1016/j.spinee.2026.04.011
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
41985687
Department(s)
Administration and Leadership
Document Type
Article