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A systematic review and meta-analysis of risk factors for reoperation after degenerative lumbar spondylolisthesis surgery

BMC Surgery volume 23, Article number: 192 (2023) Cite this article

Abstract

Background

Considering the high reoperation rate in degenerative lumbar spondylolisthesis (DLS) patients undergoing lumbar surgeries and controversial results on the risk factors for the reoperation, we performed a systematic review and meta-analysis to explore the reoperation rate and risk factors for the reoperation in DLS patients undergoing lumbar surgeries.

Methods

Literature search was conducted from inception to October 28, 2022 in Pubmed, Embase, Cochrane Library, and Web of Science. Odds ratio (OR) was used as the effect index for the categorical data, and effect size was expressed as 95% confidence interval (CI). Heterogeneity test was performed for each outcome effect size, and subgroup analysis was performed based on study design, patients, surgery types, follow-up time, and quality of studies to explore the source of heterogeneity. Results of all outcomes were examined by sensitivity analysis. Publication bias was assessed using Begg test, and adjusted using trim-and-fill analysis.

Results

A total of 39 cohort studies (27 retrospective cohort studies and 12 prospective cohort studies) were finally included in this systematic review and meta-analysis. The overall results showed a 10% (95%CI: 8%-12%) of reoperation rate in DLS patients undergoing lumbar surgeries. In surgery types subgroup, the reoperation rate was 11% (95%CI: 9%-13%) for decompression, 10% (95%CI: 7%-12%) for fusion, and 9% (95%CI: 5%-13%) for decompression and fusion. An increased risk of reoperation was found in patients with obesity (OR = 1.91, 95%CI: 1.04–3.51), diabetes (OR = 2.01, 95%CI: 1.43–2.82), and smoking (OR = 1.51, 95%CI: 1.23–1.84).

Conclusions

We found a 10% of reoperation rate in DLS patients after lumbar surgeries. Obesity, diabetes, and smoking were risk factors for the reoperation.

Peer Review reports

Background

Degenerative lumbar spondylolisthesis (DLS) refers to anterolisthesis of one vertebral body over another vertebral body secondary to osteoarthritic degeneration, leading to spinal canal stenosis [1]. DLS is an aging-related disease, and its incidence is increasing under the background of the global population aging [2]. Each year, 39 million individuals are diagnosed with DLS, accounting for a global prevalence of 0.53% [3]. DLS may be accompanied with low back pain, radiculopathy, or neurogenic claudication [2].

Surgeries have been regarded as the standard treatment modality for intractable cases [4]. The proportion of lumbar surgeries increases by more than two-fold not only because of elevated prevalence of degenerative lumbar spine disease but also because of improved surgical techniques, good outcomes, and increased hospitals and surgeons [5, 6]. However, due to complications (such as fusion failure, persistent pain, and infection), progressive degenerative changes-related diseases, or an unrelated previous surgeries, some patients require reoperation [7]. Despite improvements in surgical skills and techniques, the reoperation rate is still unimproved, with a 10-year reoperation rate of about 15% [7]. Given the high prevalence and chronicity of DLS, understanding the risk factors for reoperation is important [8]. Park et al. have revealed the longitudinal trends in the lumbar reoperation rate, and the reoperation was associated with demographics, comorbidities, primary surgery type, and preoperative spinal pathology [9]. Noh et al. haven found lifestyle-related factors, such as smoking, drinking, and exercise, were associated with the higher rate of reoperation [10]. However, results of studies on the risk factors for reoperation of DLS patients remain controversial. Rabah et al., have reported that diabetes was related to greater risk of reoperation [11], while Khan et al. reported no significant association between diabetes and reoperation [12]. In the study performed by Zhong et al., obesity was found to be associated with a higher incidence of unplanned reoperations [8]. Nevertheless, Kuo et al. found that obesity was not significantly associated with the reoperation [13].

Considering the controversial results, we aimed to perform a systematic review and meta-analysis to evaluate the incidence and risk factors of reoperation in DLS patients for the purpose of improving surgical outcomes and prognosis.

Methods

Literature search strategy

This study was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [14]. Two researchers (YZC and YZ) conducted the literature search from September 28, 2022 to October 28, 2022 in Pubmed, Embase, Cochrane Library, and Web of Science. Consensus was reached by discussion; if consensus cannot be reached by discussion, a third researcher (XHF) was consulted. Search terms were “degenerative spinal diseases” OR “degenerative spondylolisthesis” OR “degenerative lumbar spondylolisthesis” OR “degenerative cervical spondylolisthesis” AND “spinal surgery” OR “fusion” OR “reoperation” OR “repeat surgery” OR “risk factor”.

Selection criteria

Studies meeting the following inclusion criteria were selected: (1) population: DLS patients; (2) patients undergoing lumbar surgeries, including decompression surgeries and fusion surgeries; (3) outcome: reoperation rate and risk factors; and (4) studies: cohort studies. The population included DLS patients and DLS patients with lumbar spinal stenosis (LSS). Fusion surgeries included posterolateral lumbar fusion (PLF) and lumbar interbody fusion (LIF). Reoperation was defined as the secondary lumbar surgeries due to progression of lumbar degenerative changes or postoperative instability [8]. Risk factors included body mass index (BMI), sex, age, diabetes, smoking, and more bleeding.

Studies were excluded by meeting one of the following criteria: (1) animal studies; (2) other degenerative spinal diseases including lumbar spine stenosis, degenerative disc disease, and degenerative cervical spondylosis; (3) not English articles; (4) unable to extract data; (5) case reports, conference abstracts, letters, reviews, and meta-analysis.

Data extraction and critical appraisal

The following data were extracted: the first author, year of publication, country, study design, patients, definition of spondylolisthesis, sample size, age, sex, BMI, disease duration, surgery types, follow-up time, number of reoperations, reasons for reoperation, reoperation methods, and risk factors of reoperation. The Newcastle–Ottawa Scale (NOS) was applied to evaluate the quality of cohort studies [15]. This scale consisted of three items: selection, comparability, and outcome. This scale was scored a total of 9 points, and divided into low quality (0–3 points), fair quality (4–6 points), and high quality (7–9 points) [15].

Statistical analysis

All statistical analyses were performed using Stata15.1 software (Stata Corporation, College Station, TX, USA). Rate was used as the effect index in the analysis of reoperation rate. Odds ratio (OR) was used as the effect index for categorical data, and effect size was represented as 95% confidence interval (CI). Heterogeneity test was performed for each outcome effect size, and results were quantified as I-squared (I2). Random-effect model was used for analysis if I2 ≥ 50%, and fixed-effect model was used if I2 < 50%. For the high heterogeneity (I2 ≥ 50%), subgroup analysis was conducted based on study design, patients, surgery types, follow-up time, and quality of studies to explore the source of heterogeneity. Sensitivity analysis was carried out for all outcomes. Begg test was used to assess publication bias for the outcome included more than 10 articles. Trim-and-fill analysis was used to adjust the publication bias. P < 0.05 was considered statistically significant.

Results

Identification of studies and characteristics of patients

A total of 7,662 articles were searched from Pubmed (n = 1026), Embase (n = 1349), Web of Science (n = 4441), and Cochrane Library (n = 846). After removing the duplicates, 5,251 articles remained. Further, 5,150 articles were excluded due to publishing as reviews or meta-analyses (n = 929), conference abstracts (n = 310), animal trials (n = 22), case reports (n = 226), and letters (n = 9), not English articles (n = 112), and topic not meeting the requirements (n = 3542). In the remaining 101 articles, we further excluded 3 articles unable to extract data, 29 articles reporting other degenerative spinal diseases, and 30 articles with topic not meeting the requirements. Finally, 39 cohort studies were retained in this meta-analysis [7, 8, 10,11,12,13, 16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48], with 27 retrospective cohort studies and 12 prospective cohort studies. The flow diagram of our searching was displayed in Fig. 1. In the included studies, 28 studies were assessed as fair quality, and 11 studies were assessed as high quality. Characteristics of the included studies were presented in Table 1.

Fig. 1
figure 1

Flowchart of identifying studies

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Table 1 Characteristics of included patients
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Overall results and subgroup analysis results of reoperation rate

This meta-analysis showed a 10% (95%CI: 8%-12%) of reoperation rate in DLS patients (Fig. 2). A high heterogeneity was observed in the results (I2 = 99.3%). To explore the source of heterogeneity, subgroup analyses were performed. In study design subgroup, 10% of reoperation rate was found in both prospective cohort study (95%CI: 7%-13%) and retrospective cohort study (95%CI: 8%-13%). In patients subgroup, DLS patients showed 11% of reoperation rate (95%CI: 8%-13%) and DLS patients with LSS showed 10% of reoperation rate (95%CI: 6%-13%). In surgery types subgroup, the reoperation rate was 11% (95%CI: 9%-13%) in patients undergoing decompression, 10% (95%CI: 7%-12%) in patients undergoing fusion, 9% (95%CI: 5%-13%) in patients undergoing decompression and fusion, and 7% (95%CI: 3%-11%) in patients undergoing other surgeries. In follow-up time subgroup, the reoperation rate was 9% (95%CI: 6%-12%), 12% (95%CI: 9%-14%), and 10% (95%CI: 6%-15%) at follow-up time < 5 years, between 5 to 10 years, and ≥ 10 years, respectively. In study quality subgroup, there was 11% (95%CI: 9%-13%) of reoperation rate in studies with fair quality and 7% (95%CI: 5%-10%) of reoperation rate in studies with high quality. The overall and subgroup analysis results were shown in Table 2.

Fig. 2
figure 2

Forest plot regarding to reoperation rate

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Table 2 Meta analysis of reoperation rate
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Meta-analysis of risk factors for reoperation

The meta-analysis showed that obesity (OR = 1.91, 95%CI: 1.04–3.51, I2 = 53.1%), diabetes (OR = 2.01, 95%CI: 1.43–2.82, I2 = 0%), and smoking (OR = 1.51, 95%CI: 1.23–1.84, I2 = 0%) were associated with an increased risk of reoperation. Age (OR = 0.99, 95%CI: 0.95–1.03, I2 = 78.4%), sex (OR = 1.31, 95%CI: 0.83–2.05, I2 = 60.4%), and more bleeding (OR = 0.86, 95%CI: 0.07–10.22, I2 = 87.5%) were not associated with the reoperation. The overall results were demonstrated in Table 3. Forest plots regarding to obesity, diabetes, and smoking were demonstrated in Fig. 3A, B, and C, respectively.

Table 3 Risk factors for the reoperation of DLS patients after surgeries
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Fig. 3
figure 3

Forest plots regarding to obesity (A), diabetes (B), and smoking (C)

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Systematic review of risk factors for reoperation

This systematic review examined two literatures about the obesity. Chan et al. carried out a retrospective cohort study of obesity and reoperation after lumbar surgery [23]. As expected, significant higher risk of reoperation was found in patients who were obese [23]. Similar evidence was supported by Rabah et al. that an increase of one unit in BMI was associated with 4% increased risk of reoperation [11]. Moreover, study of Chan et al. showed addition of fusion was associated with higher risk of reoperation [23]. Rabah et al. found operative time > 5 h to be associated with an increased risk of reoperation [11]. A study consisted of 5-year follow-up indicated that having an index of fusion operation and perioperative complications was associated with the increased odds of reoperation [13]. Compared to intervertebral fusion, patients undergoing posterolateral fusion had 4.02-times risk of reoperation [8]. In addition, Gerling et al. have reported that patients with 2/3 moderate or severe stenotic levels, predominant back pain, no physical therapy, and greater leg pain score at baseline indicated higher reoperation rate [26].

Assessment of publication bias and sensitivity analysis

Sensitivity analysis was performed by sequentially removing the study to assess the robustness of overall results. All results of sensitivity analysis were consistent with those of the main analysis (Tables 2 and 3). By funnel plot, we detected an evidence of publication biases (Z = 2.91, P = 0.004) (Table 2, Supplementary Fig. 1A). Therefore, a trim-and-fill method was utilized to fill the missing data to eliminate the impact of publication bias. Funnel plot with missing data filled was demonstrated in Supplementary Fig. 1B. Before filled, reoperation rate was 10% (95%CI: 8%-12%). After filled, reoperation rate was 11% (95%CI: 9%-13%).

Discussion

The reoperation rate of DLS patients undergoing lumbar surgeries remains high in spite of improved surgical skills and techniques; therefore, exploring risk factors of reoperation is important [7, 8]. Considering the controversial results in the risk factors [8, 11,12,13], we performed a systematic review and meta-analysis based on currently available studies to analyze the reoperation rate and risk factors. In this study, we found a 10% of reoperation rate in DLS patients after lumbar surgeries. Obesity, diabetes, and smoking were identified as risk factors for the reoperation.

Several previous studies have reported the reoperation rate after lumbar surgeries in DLS patients [7, 49,50,51,52]. The reoperation rate was reported as 12.4% from 1990 to 1993 and 14.0% from 1997 to 2000 [51]. Ghogawala et al. proved that the reoperation rate was 15% at 1 year after the surgery in DLS patients only undergoing decompression [52]. In the present studies, the reoperation rate was found nearly the same as that reported in previous studies [7]. The reoperation rate in DLS patients was 15.7% at the mean follow-up of 8.2 years [7]. For patients undergoing fusion procedures, the cumulative reoperation rate was 14% [49]. Another report demonstrated that the reoperation rate ranged from 5.8% to 16.3% according to the type of surgeries [50]. Similar to the studies mentioned above, in our study, the reoperation rate of DLS was 10%, ranging from 8 to 12%. Our results may be useful for clinicians to evaluate the reoperation rate.

Identifying risk factors of reoperation for patients after lumbar surgeries is of clinical interest. In this study, obesity, diabetes, and smoking were found to be associated with higher risk of reoperation. Rabah et al. and Chan et al. have confirmed that smoking status was associated with greater risk of reoperation [11, 23]. Also, there were several studies reporting the positive association between obesity and reoperation of patients undergoing lumbar surgeries [8, 23]. This can be explained by that obese patients were more likely to be frail [53, 54], and frail patients had 56% increased odds of reoperation after lumbar surgery [23].

Animal studies have long recognized the close association between diabetes and lumbar spine disorders [55,56,57]. Diabetic models have revealed some harmful changes, such as increase of toxic end products of glycation, expression of matrix metalloproteinases 2 related to extracellular matrix degradation, and hyperglycemia-induced intervertebral disc inflammation, promoting intervertebral disc degeneration process [58,59,60]. Studies have revealed that diabetes was closely associated with degenerative lumbar spine disorders [61, 62]. Park et al. have found the influence of diabetes on the prevalence of lumbar spine surgeries, indicating that diabetes may be a factor aggravating lumbar spine disorders [62]. In Park et al. study, patients with diabetes underwent more lumbar surgeries than those without diabetes [62]. Their finding suggested that diabetes was significantly associated with the increased number of lumbar spine surgeries, and this finding is of critical importance because it revealed that diabetes may be an incentive for the increase of the severity of lumbar spine disorders, which ultimately led to the necessity of surgeries [62]. In this meta-analysis, diabetes was identified as a risk factor for the reoperation of DLS patients undergoing lumbar surgeries. This was consistent with the findings from Zhong et al. [8] Our findings suggested that when treating DLS patients with diabetes, physicians should pay more attention to glycemic control for the purpose of decreasing the risk of reoperation.

This meta-analysis explores the reoperation rate and risk factors for the reoperation. Results show that there is 10% of reoperation after lumbar surgeries, and obesity, diabetes, and smoking are found to increase the risk of reoperation. Our findings suggest that DLS patients should control glycemic level and weight, and reduce smoking to decrease the risk of reoperation. There are some limitations in this study. First, all fusion techniques (PLF and LIF) were put together. Due to the limitations of the included studies, it is unable to further analyze the reoperation rate in DLS patients undergoing the single fusion technique. Second, the number of studies reporting the risk factors of reoperation is relatively small, and some outcomes can only be qualitatively described, which may affect the stability of the results. Third, the risk of reoperation may be different according to the severity of lumbar spondylolisthesis and the first surgical methods; however, data provided in the currently available studies are insufficient to further analyze. Future meta-analysis including more relevant studies are needed to verify our findings and to explore the effect of lumbar spondylolisthesis severity and the first surgical methods on the risk of reoperation.

Conclusion

Our meta-analysis found 10% of reoperation rate in DLS patients undergoing lumbar surgeries, and identified obesity, diabetes, and smoking as risk factors for the reoperation. Our findings suggested that patients should improve glycemic level and weight, and quit smoking to reduce the reoperation after lumbar surgery.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

DLS:

Degenerative lumbar spondylolisthesis

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

BMI:

Body mass index

NOS:

Newcastle-Ottawa Scale

OR:

Odds ratio

CI:

Confidence interval

References

  1. Bydon M, Alvi MA, Goyal A. Degenerative lumbar spondylolisthesis: definition, natural history, conservative management, and surgical treatment. Neurosurg Clin N Am. 2019;30:299–304.

    Article  PubMed  Google Scholar 

  2. Wang YXJ, Káplár Z, Deng M, Leung JCS. Lumbar degenerative spondylolisthesis epidemiology: a systematic review with a focus on gender-specific and age-specific prevalence. J Orthop Translat. 2017;11:39–52.

    Article  PubMed  Google Scholar 

  3. Ravindra VM, Senglaub SS, Rattani A, Dewan MC, Härtl R, Bisson E, et al. Degenerative lumbar spine disease: estimating global incidence and worldwide volume. Global spine journal. 2018;8:784–94.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Karsy M, Bisson EF. Surgical versus nonsurgical treatment of lumbar spondylolisthesis. Neurosurg Clin N Am. 2019;30:333–40.

    Article  PubMed  Google Scholar 

  5. Kim CH, Chung CK, Choi Y, Kim MJ, Kim MJ, Shin S, et al. Increased proportion of fusion surgery for degenerative lumbar spondylolisthesis and changes in reoperation rate: a nationwide cohort study with a minimum 5-year follow-up. Spine. 2019;44:346–54.

    Article  PubMed  Google Scholar 

  6. Gaderer C, Schaumann A, Schulz M, Thomale UW. Neuroendoscopic lavage for the treatment of CSF infection with hydrocephalus in children. Child’s Nerv Syst. 2018;34:1893–903.

    Article  CAS  Google Scholar 

  7. Moayeri N, Rampersaud YR. Revision surgery following minimally invasive decompression for lumbar spinal stenosis with and without stable degenerative spondylolisthesis: a 5- to 15-year reoperation survival analysis. J Neurosurg Spine. 2021;36:1–7.

  8. Zhong W, Liang X, Luo X, Huang T, Quan Z. Complications rate of and risk factors for the unplanned reoperation of degenerative lumbar spondylolisthesis in elderly patients: a retrospective single-Centre cohort study of 33 patients. BMC Geriatr. 2020;20:301.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Park MS, Ju YS, Moon SH, Kim TH, Oh JK, Sung PS, et al. Reoperation rates after posterior lumbar spinal fusion surgery according to preoperative diagnoses: a national population-based cohort study. Clin Neurol Neurosurg. 2019;184:105408.

    Article  PubMed  Google Scholar 

  10. Noh SH, Cho PG, Kim KN, Lee B, Lee JK, Kim SH. Risk factors for reoperation after lumbar spine surgery in a 10-year Korean national health insurance service health examinee cohort. Sci Rep. 2022;12:4606.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Rabah NM, Khan HA, Shost M, Beckett J, Mroz TE, Steinmetz MP. Predictors of operative duration and complications in single-level posterior interbody fusions for degenerative spondylolisthesis. World neurosurgery. 2021;151:e317–23.

    Article  PubMed  Google Scholar 

  12. Khan JM, Michalski J, Basques BA, Louie PK, Chen O, Hayani Z, et al. Do Clinical outcomes and sagittal parameters differ between diabetics and nondiabetics for degenerative spondylolisthesis undergoing lumbar fusion? Global spine journal. 2020;10:286–93.

    Article  PubMed  Google Scholar 

  13. Kuo CC, Merchant M, Kardile MP, Yacob A, Majid K, Bains RS. In Degenerative Spondylolisthesis, Unilateral Laminotomy for Bilateral Decompression Leads to Less Reoperations at 5 Years When Compared to Posterior Decompression With Instrumented Fusion: a propensity-matched retrospective analysis. Spine. 2019;44:1530–7.

    Article  PubMed  Google Scholar 

  14. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(264–9):w64.

    PubMed  Google Scholar 

  15. Xue X, Lu CL, Jin XY, Liu XH, Yang M, Wang XQ, et al. Relationship between serum uric acid, all-cause mortality and cardiovascular mortality in peritoneal dialysis patients: systematic review and meta-analysis of cohort studies. BMJ Open. 2021;11:e052274.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Badhiwala JH, Leung SN, Jiang F, Wilson JRF, Akbar MA, Nassiri F, et al. In-hospital course and complications of laminectomy alone versus laminectomy plus instrumented posterolateral fusion for lumbar degenerative spondylolisthesis: a retrospective analysis of 1804 patients from the NSQIP Database. Spine. 2021;46:617–23.

    Article  PubMed  Google Scholar 

  17. Bisson EF, Mummaneni PV, Virk MS, Knightly J, Alvi MA, Goyal A, et al. Open versus minimally invasive decompression for low-grade spondylolisthesis: analysis from the Quality Outcomes Database. J neurosurg Spine. 33(3):349-59.

  18. Blumenthal C, Curran J, Benzel EC, Potter R, Magge SN, Harrington JF Jr, et al. Radiographic predictors of delayed instability following decompression without fusion for degenerative grade I lumbar spondylolisthesis. J Neurosurg Spine. 2013;18:340–6.

    Article  PubMed  Google Scholar 

  19. Booth KC, Bridwell KH, Eisenberg BA, Baldus CR, Lenke LG. Minimum 5-year results of degenerative spondylolisthesis treated with decompression and instrumented posterior fusion. Spine. 1999;24:1721–7.

    Article  CAS  PubMed  Google Scholar 

  20. Chan AK, Bisson EF, Bydon M, Glassman SD, Foley KT, Potts EA, et al. A comparison of minimally invasive transforaminal lumbar interbody fusion and decompression alone for degenerative lumbar spondylolisthesis. Neurosurg Focus. 2019;46:E13.

    Article  PubMed  Google Scholar 

  21. Chan AK, Bisson EF, Bydon M, Glassman SD, Foley KT, Potts EA, et al. Laminectomy alone versus fusion for grade 1 lumbar spondylolisthesis in 426 patients from the prospective Quality Outcomes Database. J Neurosurg Spine. 2018;30:234–41.

    Article  PubMed  Google Scholar 

  22. Chan AK, Bisson EF, Bydon M, Foley KT, Glassman SD, Shaffrey CI, et al. A Comparison of Minimally Invasive and Open Transforaminal Lumbar Interbody Fusion for Grade 1 Degenerative Lumbar Spondylolisthesis: An Analysis of the Prospective Quality Outcomes Database. Neurosurgery. 2020;87:555–62.

    Article  PubMed  Google Scholar 

  23. Chan V, Witiw CD, Wilson JRF, Wilson JR, Coyte P, Fehlings MG. Frailty is an important predictor of 30-day morbidity in patients treated for lumbar spondylolisthesis using a posterior surgical approach. Spine J. 2022;22:286–95.

    Article  PubMed  Google Scholar 

  24. Cheung JP, Cheung PW, Cheung KM, Luk KD. Decompression without Fusion for Low-Grade Degenerative Spondylolisthesis. Asian Spine J. 2016;10:75–84.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Georgiou S, Saggi S, Wu HH, Metz L. Comparison of 90-day complications and two-year reoperation rates between anterior and posterior interbody fusion for single-level degenerative spondylolisthesis. N Am Spine Soc J. 2022;10:100127.

    PubMed  PubMed Central  Google Scholar 

  26. Gerling MC, Leven D, Passias PG, Lafage V, Bianco K, Lee A, et al. Risk Factors for Reoperation in Patients Treated Surgically for Degenerative Spondylolisthesis: a subanalysis of the 8-year data from the SPORT Trial. Spine. 2017;42:1559–69.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Hayashi K, Toyoda H, Terai H, Hoshino M, Suzuki A, Takahashi S, et al. Comparison of minimally invasive decompression and combined minimally invasive decompression and fusion in patients with degenerative spondylolisthesis with instability. J Clin Neurosci. 2018;57:79–85.

    Article  PubMed  Google Scholar 

  28. Irmola TM, Häkkinen A, Järvenpää S, Marttinen I, Vihtonen K, Neva M. Reoperation Rates Following Instrumented Lumbar Spine Fusion. Spine. 2018;43:295–301.

    Article  PubMed  Google Scholar 

  29. Joelson A, Nerelius F, Holy M, Sigmundsson FG. Reoperations after decompression with or without fusion for L4–5 spinal stenosis with or without degenerative spondylolisthesis: a study of 6,532 patients in Swespine, the national Swedish spine register. Acta Orthop. 2021;92:264–8.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Joelson A, Nerelius F, Holy M, Sigmundsson FG. Reoperations After Decompression With or Without Fusion for L3–4 Spinal Stenosis With Degenerative Spondylolisthesis: A Study of 372 Patients in Swespine, the National Swedish Spine Register. Clini Spine Surg. 2022;35:E389–93.

    Article  Google Scholar 

  31. Karsy M, Chan AK, Mummaneni PV, Virk MS, Bydon M, Glassman SD, et al. Outcomes and complications with age in spondylolisthesis: an evaluation of the elderly from the quality outcomes database. Spine. 2020;45:1000–8.

    Article  PubMed  Google Scholar 

  32. Kato M, Namikawa T, Matsumura A, Konishi S, Nakamura H. Radiographic risk factors of reoperation following minimally invasive decompression for lumbar canal stenosis associated with degenerative scoliosis and spondylolisthesis. Global Spine J. 2017;7:498–505.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Katuch V, Grega R, Knorovsky K, Banoci J, Katuchova J, Sasala M, et al. Comparison between posterior lumbar interbody fusion and transforaminal lumbar interbody fusion in the management of lumbar spondylolisthesis. Bratisl Lek Listy. 2021;122:653–6.

    CAS  PubMed  Google Scholar 

  34. Kelly JP, Alcala-Marquez C, Dawson JM, Mehbod AA, Pinto MR. Treatment of degenerative spondylolisthesis by instrumented posterolateral versus instrumented posterolateral with transforaminal lumbar interbody single-level fusion. J Spine Surg (Hong Kong). 2019;5:351–7.

    Article  Google Scholar 

  35. Khan JM, Harada GK, Basques BA, Nolte MT, Louie PK, Iloanya M, et al. Patients with predominantly back pain at the time of lumbar fusion for low-grade spondylolisthesis experience similar clinical improvement to patients with predominantly leg pain: mid-term results. Spine J. 2020;20:276–82.

    Article  PubMed  Google Scholar 

  36. Lee CH, Kim CH, Chung CK, Choi Y, Kim MJ, Yim D, et al. Long-term effect of diabetes on reoperation after lumbar spinal surgery: a nationwide population-based sample cohort study. World Neurosurg. 2020;139:e439–48.

    Article  PubMed  Google Scholar 

  37. Liang Z, Xu X, Rao J, Chen Y, Wang R, Chen C. Clinical evaluation of Paraspinal mini-tubular lumbar decompression and minimally invasive Transforaminal lumbar interbody fusion for lumbar spondylolisthesis grade i with lumbar spinal stenosis: a cohort study. Front Surg. 2022;9:906289.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Macki M, Bydon M, Weingart R, Sciubba D, Wolinsky JP, Gokaslan ZL, et al. Posterolateral fusion with interbody for lumbar spondylolisthesis is associated with less repeat surgery than posterolateral fusion alone. Clin Neurol Neurosurg. 2015;138:117–23.

    Article  PubMed  Google Scholar 

  39. Mimura T, Tsutsumimoto T, Yui M, Misawa H. Does fusion status following posterolateral lumbar fusion in the treatment for stable lumbar degenerative spondylolisthesis affect the long-term surgical outcomes? A propensity score-weighted analysis of consecutive patients. J Orthop Sci. 2022;27:990–4.

    Article  PubMed  Google Scholar 

  40. Minamide A, Simpson AK, Okada M, Enyo Y, Nakagawa Y, Iwasaki H, et al. Microendoscopic Decompression for Lumbar Spinal Stenosis With Degenerative Spondylolisthesis: The Influence of Spondylolisthesis Stage (Disc Height and Static and Dynamic Translation) on Clinical Outcomes. Clin Spine Surg. 2019;32:E20–6.

    Article  PubMed  Google Scholar 

  41. Nyström B, Jin S, Schillberg B, Moström U, Lundin P, Taube A. Are degenerative spondylolisthesis and further slippage postoperatively really issues in spinal stenosis surgery? Scand J Pain. 2020;20:307–17.

    Article  PubMed  Google Scholar 

  42. Rihn JA, Radcliff K, Hilibrand AS, Anderson DT, Zhao W, Lurie J, et al. Does obesity affect outcomes of treatment for lumbar stenosis and degenerative spondylolisthesis? Analysis of the Spine Patient Outcomes Research Trial (SPORT). Spine. 2012;37:1933–46.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Salimi H, Toyoda H, Terai H, Yamada K, Hoshino M, Suzuki A, et al. Mid-term changes in spinopelvic sagittal alignment in lumbar spinal stenosis with coexisting degenerative spondylolisthesis or scoliosis after minimally invasive lumbar decompression surgery: minimum five-year follow-up. Spine J. 2022;22:819–26.

    Article  PubMed  Google Scholar 

  44. Sato S, Yagi M, Machida M, Yasuda A, Konomi T, Miyake A, et al. Reoperation rate and risk factors of elective spinal surgery for degenerative spondylolisthesis: minimum 5-year follow-up. Spine J. 2015;15:1536–44.

    Article  PubMed  Google Scholar 

  45. Sugiura T, Okuda S, Takenaka S, Nagamoto Y, Matsumoto T, Takahashi Y, et al. Comparing Investigation Between Bilateral Partial Laminectomy and Posterior Lumbar Interbody Fusion for Mild Degenerative Spondylolisthesis. Clin Spine Surg. 2021;34:E403–9.

    Article  PubMed  Google Scholar 

  46. Takaoka H, Inage K, Eguchi Y, Shiga Y, Furuya T, Maki S, et al. Comparison between intervertebral oblique lumbar interbody fusion and transforaminal lumbar interbody fusion: a multicenter study. Sci Rep. 2021;11:16673.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Veresciagina K, Mehrkens A, Schären S, Jeanneret B. Minimum ten-year follow-up of spinal stenosis with degenerative spondylolisthesis treated with decompression and dynamic stabilization. J Spine Surg (Hong Kong). 2018;4:93–101.

    Article  Google Scholar 

  48. Vorhies JS, Hernandez-Boussard T, Alamin T. Treatment of Degenerative Lumbar Spondylolisthesis With Fusion or Decompression Alone Results in Similar Rates of Reoperation at 5 Years. Clin Spine Surg. 2018;31:E74–9.

    Article  PubMed  Google Scholar 

  49. Ghogawala Z, Dziura J, Butler WE, Dai F, Terrin N, Magge SN, et al. Laminectomy plus Fusion versus Laminectomy Alone for Lumbar Spondylolisthesis. N Engl J Med. 2016;374:1424–34.

    Article  CAS  PubMed  Google Scholar 

  50. Schöller K, Alimi M, Cong GT, Christos P, Härtl R. Lumbar Spinal Stenosis Associated With Degenerative Lumbar Spondylolisthesis: A Systematic Review and Meta-analysis of Secondary Fusion Rates Following Open vs Minimally Invasive Decompression. Neurosurgery. 2017;80:355–67.

    Article  PubMed  Google Scholar 

  51. Mardjetko SM, Connolly PJ, Shott S. Degenerative lumbar spondylolisthesis. A meta-analysis of literature 1970–1993. Spine. 1994;19:2256s–65s.

    Article  CAS  PubMed  Google Scholar 

  52. Ghogawala Z, Benzel EC, Amin-Hanjani S, Barker FG 2nd, Harrington JF, Magge SN, et al. Prospective outcomes evaluation after decompression with or without instrumented fusion for lumbar stenosis and degenerative Grade I spondylolisthesis. J Neurosurg Spine. 2004;1:267–72.

    Article  PubMed  Google Scholar 

  53. Liao Q, Zheng Z, Xiu S, Chan P. Waist circumference is a better predictor of risk for frailty than BMI in the community-dwelling elderly in Beijing. Aging Clin Exp Res. 2018;30:1319–25.

    Article  PubMed  Google Scholar 

  54. Rietman ML, van der AD, van Oostrom SH, Picavet HSJ, Dollé MET, van Steeg H, et al. The Association between BMI and Different Frailty Domains: A U-Shaped Curve? J Nutr Health Aging. 2018;22:8–15.

    Article  CAS  PubMed  Google Scholar 

  55. Fields AJ, Berg-Johansen B, Metz LN, Miller S, La B, Liebenberg EC, et al. Alterations in intervertebral disc composition, matrix homeostasis and biomechanical behavior in the UCD-T2DM rat model of type 2 diabetes. J Orthop Res. 2015;33:738–46.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Illien-Junger S, Grosjean F, Laudier DM, Vlassara H, Striker GE, Iatridis JC. Combined anti-inflammatory and anti-AGE drug treatments have a protective effect on intervertebral discs in mice with diabetes. PLoS One. 2013;8:e64302.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Illien-Jünger S, Lu Y, Qureshi SA, Hecht AC, Cai W, Vlassara H, et al. Chronic ingestion of advanced glycation end products induces degenerative spinal changes and hypertrophy in aging pre-diabetic mice. PLoS One. 2015;10:e0116625.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Cheng X, Ni B, Zhang Z, Liu Q, Wang L, Ding Y, et al. Polyol pathway mediates enhanced degradation of extracellular matrix via p38 MAPK activation in intervertebral disc of diabetic rats. Connect Tissue Res. 2013;54:118–22.

    Article  CAS  PubMed  Google Scholar 

  59. Chen S, Liao M, Li J, Peng H, Xiong M. The correlation between microvessel pathological changes of the endplate and degeneration of the intervertebral disc in diabetic rats. Exp Ther Med. 2013;5:711–7.

    Article  PubMed  Google Scholar 

  60. Won HY, Park JB, Park EY, Riew KD. Effect of hyperglycemia on apoptosis of notochordal cells and intervertebral disc degeneration in diabetic rats. J Neurosurg Spine. 2009;11:741–8.

    Article  PubMed  Google Scholar 

  61. Agius R, Galea R, Fava S. Bone mineral density and intervertebral disc height in type 2 diabetes. J Diabetes Complications. 2016;30:644–50.

    Article  PubMed  Google Scholar 

  62. Park CH, Min KB, Min JY, Kim DH, Seo KM, Kim DK. Strong association of type 2 diabetes with degenerative lumbar spine disorders. Sci Rep. 2021;11:16472.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

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Funding

This study was funded by Sichuan Province Key Research and Development Project (2022YFS0418).

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Authors and Affiliations

  1. Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, P.R. China

    Yuzhou Chen

  2. Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, No.39 Shi-Er-Qiao Road, Jinniu District, Chengdu, 610075, P.R. China

    Yuzhou Chen, Yongtao Wang & Xiaohong Fan

  3. Department of Traditional Chinese Medicine, The Traditional Chinese Medicine Hospital of Wenjiang District, Chengdu, 611130, P.R. China

    Yi Zhou

  4. Department of Anorectal, The Traditional Chinese Medicine Hospital of Wenjiang District, Chengdu, 611130, P.R. China

    Junlong Chen

  5. Department of Gynecology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, P.R. China

    Yiping Luo

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  3. Junlong Chen
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Contributions

YC and XF designed the study. YC wrote the manuscript. YZ, JC, YL and YW collected, analyzed and interpreted the data. XF critically reviewed, edited and approved the manuscript. All authors read and approved the final manuscript.

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Correspondence to Xiaohong Fan.

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Supplementary Information

Additional file 1: Supplementary figure 1.

Funnel plot for publication bias before and after trim-and-fillanalysis.

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Chen, Y., Zhou, Y., Chen, J. et al. A systematic review and meta-analysis of risk factors for reoperation after degenerative lumbar spondylolisthesis surgery. BMC Surg 23, 192 (2023). https://doi.org/10.1186/s12893-023-02082-8

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  • DOI: https://doi.org/10.1186/s12893-023-02082-8

Keywords

BMC Surgery

ISSN: 1471-2482

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