All Cause 5-Year Revision Rates of Patients with Surgically Treated Lumbar Stenosis with and Without Instrumented Arthrodesis

Study Design: Retrospective study using the MarketScan database. Objective: This study sought to investigate: (1) real-world surgical management, and (2) 5-year all-cause reoperation rates after index surgical treatment. Methods: Patients 18 – 65 years old with 2-year minimum follow-up undergoing single-level lumbar decompression were included. Patients were stratified based on the presence of spondylolisthesis (+LISTH) and arthrodesis (+FUSION) during the index procedure. Those undergoing multi-level, endoscopic, revision, corpectomy/transpedicular, and thoracic/cervical decompression were excluded, as were those with infectious, traumatic, or neoplastic etiologies. The time elapsed between primary and any revision surgery was determined. Follow-up was terminated at 5 years post-operatively. Results: In total, 86 708 adult patients undergoing single-level lumbar decompression were included. Spondylolisthesis was observed in 10.8%. Of + LISTH, 90.7% underwent additional arthrodesis. Of -LISTH, 89.8% underwent decompression alone. Among + LISTH, at 5-year post-operatively, 15.2% vs 20.3% of patients with +FUSION vs -FUSION had undergone surgical revision involving the lumbar spine (aHR 0.76, P = 0.009). Conversely, among those without spondylolisthesis (-LISTH), 17.6% vs 17.6% of those with +FUSION vs -FUSION had undergone revision at 5-year (aHR 0.94, P = 0.116). In the -LISTH group, patients demonstrated higher occurrence of revision over 2 – 5 years (aHR 1.43, P < 0.0001) among patients treated with additional arthrodesis. Conclusions: In this retrospective cohort study of patients undergoing surgical treatment for single-level lumbar stenosis, patients with spondylolisthesis who underwent arthrodesis with decompression had lower revision rates at 5-year follow-up.