Association of age with incidence and timing of recurrence after microdiscectomy for lumbar disc herniation
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ORIGINAL ARTICLE
Association of age with incidence and timing of recurrence after microdiscectomy for lumbar disc herniation Alessandro Siccoli1,2 · Marc L. Schröder1 · Victor E. Staartjes1,3,4 Received: 21 August 2020 / Revised: 9 November 2020 / Accepted: 2 December 2020 © The Author(s) 2020
Abstract Objective Recurrent lumbar disc herniation (LDH) is the most frequent reason for reoperation after lumbar microdiscectomy. While several risk factors for recurrent LDH have been well-described, the effect of age on recurrence remains unclear, especially concerning the timing of recurrent LDH. Methods From a prospective registry, we identified all patients who underwent tubular microdiscectomy for LDH. Recurrent LDH was defined as reoperation for LDH at the same index level and side. The associations among age and incidence of recurrent LDH as well as on time to recurrent LDH were statistically evaluated using multivariable analysis of covariance, linear regression, and Cox proportional hazards modelling. Results Of the 3013 patients who underwent surgery for LDH, 166 (5.5%) had to undergo reoperation due to LDH recurrence. Uni- and multivariable analysis revealed no influence of age on the incidence of recurrent LDH (both p > 0.05). Linear regression indicated earlier reoperation in older patients, both with (β = −0.248) and without (β = −0.374) correction for confounders (both p 80 or with a body mass index (BMI) > 35 or American Society of Anesthesiologists (ASA) score > 2 were not eligible to undergo surgery in such a setting due to local insurance regulation restrictions.
Ethical aspects This institutional registry was approved by the local institutional review board (Medical Research Ethics Committees United, Registration Number: W16.065), and this study was performed according to the Declaration of Helsinki. All individual patients in this study provided written informed consent.
Data collection LDH recurrence was defined as reoperation for recurrent LDH at the same index and the same side. For all patients included in this study, any recurrence of LDH up to this study was tracked and noted, as well as the time from surgery to reoperation. Patients were systematically categorized into two groups, one with an LDH reoperation and one
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European Spine Journal
without any. Patients completed a standardized questionnaire containing a numeric rating scale (NRS) for back pain and leg pain severity, as well as a validated Dutch version of the Oswestry Disability Index (ODI) as a measure of functional disability. After 12 and 24 months after surgical intervention, follow-up questionnaires containing the same PROMs were automatically sent to the patients via e-mail.[16]
Statistical analysis Continuous data are given as mean ± standard deviation, and categorical data as numbers (percentages). For determining intergroup differences in age, we conducted a Student’s t test. Additionally, we performed analysis of covariance (ANCOVA) with age as dependent value and LDH recurrence, gender, smoking status, and BMI
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