Reoperations Following Lumbar Spinal Canal Stenosis.

In the current clinical scenario, restenosis following the primary surgical procedure for lumbar canal stenosis is being frequently noticed. A number of studies have evaluated the reoperation rates following different surgical procedures for lumbar canal stenosis. However, a dilemma still exists about the surgical procedures, associated comorbidities and reoperation rates. In this study, we have reviewed the existing literature for lumbar canal stenosis surgery and their reoperation rates. A PubMed search for all papers stating "reoperation after spinal stenosis," "revision surgery after spinal stenosis," and "reoperations and lumbar canal stenosis" were explored. A total of 440 publications were found, of which 23 publications were shortlisted. The existing literature on reoperation rates after surgery for lumbar canal stenosis was reviewed and analyzed. From the literature search, 29680 patients who underwent surgeries for spinal stenosis have been included in the review. 11.65% ± 4.25% of them underwent reoperations following the primary procedure with a followup period of 6.80 ± 3.90 years. Fenestration surgeries showed an average reoperation rate of 7.58% ± 5.29% in 8.28 ± 6.26 years followup as compared to laminectomy alone (12.70% ± 7.49%, 6.50 ± 2.12 years followup). Laminectomy with or without fusion showed a reoperation rate of 11.22% ± 4.25% in 6.00 ± 2.60 years followup period. The comparative results of these studies were however not significant. The causes of reoperation were multifactorial ranging from the type of procedure performed, associated comorbidities or smoking. Statistical data do not indicate the superiority of any particular type of surgery, which reduces the rate of reoperation. The causes for reoperation are inadequate decompression or instability. The literature does not give statistics for these complications in the papers. Smoking is an independent risk factor for revision surgery. Diabetes reduces the time interval between the initial surgery and the revision surgery. This review highlights the causes of reoperations in various lumbar stenosis surgeries, associated comorbidities and expected outcome.