Article Figures & Data
Figures
- Figure 1
(A) Preoperative magnetic resonance images, (B) preoperative postdiscography computed tomographic image, (C) postoperative radiograph, (D) 6-mo postoperative radiograph with spondylolisthesis, and (E) postoperative radiograph of index level revision, circumferential fusion.
- Figure 2
(A) Postoperative radiograph of index level L5-S1 total disc replacement (TDR) and (B) revision at adjacent level, L4-L5, with insertion of a TDR.
- Figure 3
Time to index level revision spine surgery and final reported outcome score for each patient (n = 16). Patients 11 and 16 also had adjacent-level revision spine surgery. Patient 13 underwent revision surgery at another clinic.
- Figure 4
Time to adjacent level revision spine surgery for clinical adjacent segment pathology, and final reported outcome score for each patient (n = 18). Patients 11 and 16 also had index-level revision spine surgery.
- Figure 5
Mean change from baseline and 95% CI for visual analog scale (VAS) (0 = no pain to 100 = worst pain) back and leg pain scores at follow-up times after surgery. ASD = adjacent segment disease; T1 = first year after primary surgery; T2 = final year after primary surgery; T3 = first year after revision surgery; T4 = final year after revision surgery with reported outcome. Most mean scores were above the minimum clinically important difference (MCID).
- Figure 6
Mean change from baseline and 95% CI for Oswestry Disability Index (ODI) (0 = no disability to = 100 worst disability) and Roland-Morris Disability Questionnaire (RMDQ) (0 = no disability to 24 = worst disability) at follow-up times after surgery. ASD = adjacent segment disease; T1 = first year after primary surgery; T2 = final year after primary surgery; T3 = first year after revision surgery; T4 = final year after revision surgery with reported outcome. Most mean scores were above the minimum clinically important difference (MCID).
Tables
Characteristic Index-Level RSS (n = 16a) Adjacent-Level RSS (n = 18a) Gender, n (%) Female 10 (62.5) 6 (33.3) Male 6 (37.5) Age at the time of primary surgery, y, mean (SD) 43.5 (13.7) 36.9 (10.6) Index TDR level, n (%) L4-L5 2 (12.5) 6 (33.3) L5-S1 14 (87.5) 12 (66.6) Preoperative diagnosis, n (%) DDD (L4-L5) 2 (12.5) 5 (27.8) DDD (L5-S1) 8 (50.0) 8 (44.4) Internal disc disruption (L5-S1) 1 (6.3) - DDD with herniation: no previous surgery (L4-L5) - 1 (5.6) DDD with herniation: no previous surgery (L5-S1) 4 (25) 3 (16.7) Herniation: previous surgery (L5-S1) 1 (6.3) 1 (5.6) Time to RSS (mo), median (IQR) 35 (9–51) 70 (41.3–105.3) Time to final reported score, median (IQR) 84.0 (54.0–108.0) 132 (93.0–156.0) Type of revision, n (%) Anterior reconstruction (TDR/anterior lumbar interbody fusion) 1 (6.2) 14 (77.8) Posterior (fusion/decompression) 15 (93.8) 4 (22.2) Pain score,b median (IQR) VAS-back 76.5 (63.0–92.5) 82.0 (66.5–91.5) VAS-leg 69.0 (14.0–85.0) 55.5 (34.8–84.3) Disability score, median (IQR) Oswestry Disability Indexb 51.5 (42.5–57.5) 46.0 (40.0–59.0) Roland-Morris Disability Questionnairec 18.0 (14.5–19.8) 15.0 (14.0–18.5) Abbreviations: DDD, degenerative disc disease; IQR, interquartile range; RSS, revision spine surgery; TDR, total disc replacement; VAS, visual analog scale.
Note: Data are presented as n (%), unless otherwise specified.
↵a Two patients underwent both types of surgeries and are included in both groups.
↵b Score ranged from 0 (none) to 100 (worst).
↵c Score ranged from 0 (none) to 24 (worst).
RSS Group and Subgroup Anterior RSS Posterior RSS IL-RSS (n = 16) 2 14 FA None 7 total 6 PSF at IL
1 PSF at L4-L5 IL, plus extension to pelvisa
Migration None 2 PSF at IL FA + migration 2 r/o TDR+ ALIF (RRPA) 1 r/o L5-S1 TDR+ ALIF, + PSF L3-S1a
1 PSF at IL Subsidence None 3 PSF at IL r/o IDSD N/A 1 PSF at IL AL-RSS (n = 18) 14 4 IL TDR at L4-L5 5 total 4 ALIF at L5-S1 (RRPA)
1 TDR at L3-L4 (LrRPA)
3 total 1 discectomy at L5-S1
1 PSF at L5-S1
1 PSF at L4-L5 IL, plus extension to pelvisa
IL TDR at L5-S1 9 total 1 ALIF at S1-S2 (LrRPA)
8 TDR at L4-L5 (LrRPA)
1 posterior 1 r/o L5-S1 TDR+ ALIF, plus PSF L3-S1a
Abbreviations: AL, adjacent level; ALIF, anterior lumbar interbody fusion; FA, facet arthropathy; IDSD, interspinous dynamic stabilization device; IL, index level; LrRPA, left revision retroperitoneal approach; PSF, posterior spinal fusion; r/o, removal of; RRPA, right retroperitoneal approach; RSS, revision spine surgery; TDR, total disc replacement;
↵a Patients underwent both AL-RSS and IL-RSS.
Time Index Level Revision Spine Surgery Adjacent Level Revision Spine Surgery n Mean Difference (95% CI) P Value n Mean Difference (95% CI) P Value VAS-backb T1 14 29.6 (12.2, 46.9) 0.003a 12 55.2 (39.0, 71.4) <0.001a T2 14 22.6 (3.2, 41.9) 0.026 15 30.6 (11.1, 50.1) 0.005a T3 13 43.3 (26.6, 60.0) <0.001a 14 46.3 (27.6, 65.0) <0.001a T4 13 11.8 (−9.5, 33.1) 0.252 15 32.0 (12.0, 52.0) 0.004a VAS-legb T1 13 33.5 (7.2, 59.8) 0.017 11 37.4 (12.7, 62.1) 0.007a T2 13 25.9 (1.2, 50.7) 0.042 12 17.5 (−11.2, 46.2) 0.207 T3 12 41.4 (14.9, 67.9) 0.006a 11 24.5 (−0.4, 49.3) 0.053 T4 12 20.0 (−17.7, 57.7) 0.267 12 23.3 (−0.8, 47.3) 0.057 ODIb T1 14 20.7 (11.5, 29.9) <0.001a 13 27.1 (21.0, 33.2) <0.001a T2 14 15.7 (7.4, 24.0) 0.001a 15 18.3 (8.7, 28.0) 0.001a T3 13 27.8 (17.6, 37.9) <0.001a 14 20.9 (6.5, 35.2) 0.008a T4 13 18.6 (6.7, 30.5) 0.005a 15 14.9 (5.9, 24.0) 0.003a RMDQc T1 14 8.3 (5.2, 11.4) <0.001a 11 10.0 (6.8, 13.2) <0.001a T2 14 4.9 (1.5, 8.3) 0.008a 15 6.9 (3.3, 10.4) <0.001a T3 13 10.9 (7.6, 14.2) <0.001a 14 7.8 (2.4, 13.1) 0.008a T4 13 7.8 (3.7, 11.8) 0.001a 15 6.9 (3.4, 10.5) <0.001a Abbreviations: ODI, Oswestry Disability Index; RMDQ, Roland-Morris Disability Questionnaire; T1, first year after primary surgery; T2, final year after primary surgery; T3, first year after revision surgery; T4, final year after revision surgery with reported outcome; VAS, visual analog scale.
Note: A positive mean difference (change from baseline) denotes improvement in the outcome.
↵a Statistical significance achieved when P < 0.013, after applying Bonferroni correction to multiple comparisons within each outcome.
↵b Score ranged from 0 (none) to 100 (worst).
↵c Score ranged from 0 (none) to 24 (worst).
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