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"Reoperation"

Review Article

Health Services Research

Socioeconomic Implications of Recurrent Lumbar Disc Herniation: A Narrative Review
Rachel Bratescu, Anthony Robayo, Evan Wang, Chibuikem A. Ikwuegbuenyi, Lawrance K. Chung, Noah Willett, Andreas K. Demetriades, Sun-Ho Lee, Roger Härtl, AO Spine Knowledge Forum Degenerative
Neurospine 2026;23(1):94-108.   Published online January 31, 2026
DOI: https://doi.org/10.14245/ns.2551644.822

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Socioeconomic Implications of Recurrent Lumbar Disc Herniation: A Narrative Review
Neurospine. 2026;23(1):94-108.   Published online January 31, 2026
DOI: https://doi.org/10.14245/ns.2551644.822
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Socioeconomic Implications of Recurrent Lumbar Disc Herniation: A Narrative Review
Neurospine. 2026;23(1):94-108.   Published online January 31, 2026
DOI: https://doi.org/10.14245/ns.2551644.822
Close
Recurrent lumbar disc herniation (RLDH) is a common complication after discectomy, occurring in 2%–25% of patients and contributing to higher reoperation rates, reduced satisfaction, and substantial direct and indirect costs. This review evaluates the economic consequences of RLDH and the relative cost-effectiveness of available management strategies. A systematic search of OVID, MEDLINE, and the Cochrane Library was performed through August 2025. Peer-reviewed, English-language studies were included if they examined adults (≥18 years) with RLDH and reported economic data. Exclusion criteria were studies limited to primary, cervical, or thoracic herniations; animal or cadaveric models; and abstracts. Extracted variables included study design, sample size, follow-up duration, and cost components. Of 283 records identified, 220 were screened and 35 underwent full-text review. Six studies met inclusion criteria, with 2 added through citation searching. Reported costs varied considerably: repeat discectomy added $6,907 in one analysis, while fusion increased expenses by more than 350%. Across studies, repeat discectomy remained the most cost-efficient option, providing comparable outcomes with reduced perioperative expenditures. Conservative management had the lowest immediate direct costs (≈$2,300) but likely underestimates the overall burden due to unmeasured productivity losses. Annular closure devices demonstrated potential cost savings of $2,000–5,000 over 2–5 years. RLDH imposes a substantial economic burden. Heterogeneity in costing methods remains a major limitation which hinders evidence-based determinations. Greater transparency, methodological standardization, and incorporation of societal perspectives are essential to accurately assess the socioeconomic impact of RLDH.
  • 1,649 View
  • 44 Download

Original Articles

Incidence, Risk Factors, and Management of Postoperative Hematoma Following Anterior Cervical Decompression and Fusion for Degenerative Cervical Diseases
Hongwei Wang, Hailong Yu, Ning Zhang, Liangbi Xiang
Neurospine 2023;20(2):525-535.   Published online June 30, 2023
DOI: https://doi.org/10.14245/ns.2245066.533

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Incidence, Risk Factors, and Management of Postoperative Hematoma Following Anterior Cervical Decompression and Fusion for Degenerative Cervical Diseases
Neurospine. 2023;20(2):525-535.   Published online June 30, 2023
DOI: https://doi.org/10.14245/ns.2245066.533
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Incidence, Risk Factors, and Management of Postoperative Hematoma Following Anterior Cervical Decompression and Fusion for Degenerative Cervical Diseases
Neurospine. 2023;20(2):525-535.   Published online June 30, 2023
DOI: https://doi.org/10.14245/ns.2245066.533
Close
Objective
Studies discussed few risk factors for specific patients, such as duration of disease; or surgical factors, such as duration and time of surgery; or C3 or C7 involvement, which could have led to the formation of hematomas (HTs). To investigate the incidence, risk factors especially the factors mentioned above, and management of postoperative HTs following anterior cervical decompression and fusion (ACF) for degenerative cervical diseases.
Methods
Medical records of 1,150 patients who underwent ACF for degenerative cervical diseases at our hospital between 2013 and 2019 were identified and reviewed. Patients were categorized into the HT group (HT group) or normal group (no-HT group). Demographic, surgical and radiographic data were recorded prospectively to identify risk factors for HT.
Results
Postoperative HT was identified in 11 patients, with an incidence rate of 1.0% (11 of 1,150). HT occurred within 24 hours postoperatively in 5 patients (45.5%), while it occurred at an average of 4 days postoperatively in 6 patients (54.5%). Eight patients (72.7%) underwent HT evacuation; all patients were successfully treated and discharged. Smoking history (odds ratio [OR], 5.193; 95% confidence interval [CI], 1.058–25.493; p = 0.042), preoperative thrombin time (TT) value (OR, 1.643; 95% CI, 1.104–2.446; p = 0.014) and antiplatelet therapy (OR, 15.070; 95% CI, 2.663–85.274; p = 0.002) were independent risk factors for HT. Patients with postoperative HT had longer days of first-degree/intensive nursing (p < 0.001) and greater hospitalization costs (p = 0.038).
Conclusion
Smoking history, preoperative TT value and antiplatelet therapy were independent risk factors for postoperative HT following ACF. High-risk patients should be closely monitored through the perioperative period. Postoperative HT in ACF was associated with longer days of first-degree/intensive nursing and more hospitalization costs.

Citations

Citations to this article as recorded by  Crossref logo
  • Risk factors for symptomatic hematoma following cervical spine surgery: a systematic review and meta-analysis
    ChenGuang Wang, ChengHan Xu, YinGang Zhang
    Journal of Orthopaedic Surgery and Research.2026;[Epub]     CrossRef
  • Clinical characteristics of cervical myelopathy and factors associated with severe disease among patients with cervical disc herniation in a tertiary center in Palestine
    Ahmed Daqour, Heyam Shakarneh, Tala Sharaqa, Ghaya Belih, Batoul Feeno, Iba Hmouz, Shahed Nasser, Abdulsalam Alkaiyat, Ahmad Rjoub, Mohammad Abuawad
    The Egyptian Journal of Neurology, Psychiatry and Neurosurgery.2026;[Epub]     CrossRef
  • Novel Risk Factors for Postoperative Hematoma Requiring Reoperation Following Anterior Cervical Discectomy and Fusion
    Dana G. Rowe, Seeley Yoo, Connor Barrett, Emily Luo, Alissa Arango, Matthew Morris, Kerri-Anne Crowell, Russel R. Kahmke, C. Rory Goodwin, Melissa M. Erickson
    Clinical Spine Surgery.2025; 38(5): E234.     CrossRef
  • Incidence, risk factors and airway management of postoperative haematoma following anterior cervical spine surgery: a retrospective nested case-control study
    Yang Tian, Jiao Li, Guangjin Zhou, Mingya Wang, Yinyin Qu, Min Li, Jun Wang, Mao Xu, Shenglin Wang, Xiangyang Guo, Yongzheng Han
    BMJ Open.2025; 15(4): e090547.     CrossRef
  • Assessment of Clinical and Radiologic Outcomes of Biportal Endoscopic Posterior Cervical Inclinatory Foraminotomy : A Retrospective Cohort Study
    Kwan-Su Song, Pius Kim
    Journal of Korean Neurosurgical Society.2025; 68(4): 446.     CrossRef
  • Incidence of Spinal Epidural Hematoma After Anterior Cervical Decompression and Fusion: Systematic Review, Meta-Analysis, and Case Report
    Jerzy Gregorczyk, Negin Fani, Mikołaj Biegański, Jakub Mocarski, Pawel Kowalczyk, Piotr Dąbrowski, Rafał Górski, Mateusz Bielecki
    World Neurosurgery.2025; 203: 124442.     CrossRef
  • Outcome of thyroid surgery by applying a haemostatic agent with and without a drain
    S. M. Asikur Rahat, M. Mahmudul Hasan, M. Aminul I. Joarder, Rokebul H. Mazumdar, Nayeemun Akter, Ferdous Alam, Rajib Chowdhury, M. Shaukat Ali, Emdadul Hoque
    International Surgery Journal.2025; 12(12): 2096.     CrossRef
  • Risk factors and airway management of postoperative retropharyngeal hematoma following anterior cervical spine surgery: a retrospective study
    Yang Tian, Xixi Jia, Gang Li, Yongzheng Han, Xiangyang Guo, Min Li, Yinyin Qu, Mao Xu
    Journal of Orthopaedic Surgery and Research.2025;[Epub]     CrossRef
  • Screening patients requiring secondary lumbar surgery for degenerative lumbar spine diseases: a nationwide sample cohort study
    Hangeul Park, Juhee Lee, Yunhee Choi, Jun-Hoe Kim, Sum Kim, Young-Rak Kim, Chang-Hyun Lee, Sung Bae Park, Kyoung-Tae Kim, John M. Rhee, Chi Heon Kim
    Scientific Reports.2024;[Epub]     CrossRef
  • The utility of intraoperative ultrasonography for spinal cord surgery
    Hangeul Park, Jun-Hoe Kim, Chang-Hyun Lee, Sum Kim, Young-Rak Kim, Kyung-Tae Kim, Ji-hoon Kim, John M. Rhee, Woo-Young Jo, Hyongmin Oh, Hee-Pyoung Park, Chi Heon Kim, Barry Kweh
    PLOS ONE.2024; 19(7): e0305694.     CrossRef
  • Corticosteroid Effects on Upper Esophageal Sphincter Function in Anterior Cervical Discectomy and Fusion
    Chih-Jun Lai, Jo-Yu Chen, Jing-Rong Jhuang, Ming-Yen Hsiao, Tyng-Guey Wang, Yu-Chang Yeh, Dar-Ming Lai, Fon-Yih Tsuang
    Journal of Bone and Joint Surgery.2024; 106(23): 2241.     CrossRef
  • Limaprost and the Risk of Bleeding: A Self-Controlled Case Series Study
    Eun-Joo Lee, Han Eol Jeong, Yoosoo Chang, Ju-Young Shin
    Neurospine.2023; 20(4): 1490.     CrossRef
  • 8,578 View
  • 215 Download
  • 11 Web of Science
  • 12 Crossref

Spine and Spinal Cord Tumors DSPN-Neurospine Special Issue

Mechanical Failure After Total En Bloc Spondylectomy and Salvage Surgery
Shin Won Kwon, Chun Kee Chung, Young Il Won, Woon Tak Yuh, Sung Bae Park, Seung Heon Yang, Chang Hyun Lee, John M. Rhee, Kyoung-Tae Kim, Chi Heon Kim
Neurospine 2022;19(1):146-154.   Published online March 31, 2022
DOI: https://doi.org/10.14245/ns.2244092.046

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Mechanical Failure After Total En Bloc Spondylectomy and Salvage Surgery
Neurospine. 2022;19(1):146-154.   Published online March 31, 2022
DOI: https://doi.org/10.14245/ns.2244092.046
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Mechanical Failure After Total En Bloc Spondylectomy and Salvage Surgery
Neurospine. 2022;19(1):146-154.   Published online March 31, 2022
DOI: https://doi.org/10.14245/ns.2244092.046
Close
Objective
Total en bloc spondylectomy (TES) is a curative surgical method for spinal tumors. After resecting the 3 spinal columns, reconstruction is of paramount importance. We present cases of mechanical failure and suggest strategies for salvage surgery.
Methods
The medical records of 19 patients who underwent TES (9 for primary tumors and 10 for metastatic tumors) were retrospectively reviewed. Previously reported surgical techniques were used, and the surgical extent was 1 level in 16 patients and 2 levels in 3 patients. A titanium-based mesh-type interbody spacer filled with autologous and cadaveric bone was used for anterior support, and a pedicle screw/rod system was used for posterior support. Radiotherapy was performed in 11 patients (pre-TES, 5; post-TES, 6). They were followed up for 59 ± 38 months (range, 11–133 months).
Results
During follow-up, 8 of 9 primary tumor patients (89%) and 5 of 10 metastatic tumor patients (50%) survived (mean survival time, 124 ± 8 months vs. 51 ± 13 months; p = 0.11). Mechanical failure occurred in 3 patients (33%) with primary tumors and 2 patients (20%) with metastatic tumors (p = 0.63). The mechanical failure-free time was 94.4 ± 14 months (primary tumors, 95 ± 18 months; metastatic tumors, 68 ± 16 months; p = 0.90). Revision surgery was performed in 4 of 5 patients, and bilateral broken rods were replaced with dual cobalt-chromium alloy rods. Repeated rod fractures occurred in 1 of 4 patients 2 years later, and the third operation (with multiple cobalt-chromium alloy rods) was successful for over 6 years.
Conclusion
Considering the difficulty of reoperation and patients’ suffering, preemptive use of a multiple-rod system may be advisable.

Citations

Citations to this article as recorded by  Crossref logo
  • Single stage combined approach total en-bloc spondylectomy of L1 and L2 vertebrae for primary spinal and paraspinal synovial sarcoma
    Gurushankari Balakrishnan, Narayanaswamy Kathiresan, Chandra Kumar Krishnan, Vijay Sundar Ilangovan, Dileep Damodaran, Suresh Bapu Kandallu, Vijay Sankaran, Krishna Suresh, Anand Raja
    British Journal of Neurosurgery.2026; 40(2): 357.     CrossRef
  • The impact of pedicle screw transitional segment and thread distribution on postoperative rod-screw system failure
    Wen Peng, Weichao Wang, Jie Zhang, Yami Liu, Peiliang Yu, Haoling Huo, Jianzeng Ren, Zhongfa Mao, Xiaojian Wang, Yiguo Yan, Cheng Wang
    Bone & Joint Research.2026; 15(4): 383.     CrossRef
  • Reconstruction of posterior elements of the spine with femoral shaft allograft after spondylectomy for En bloc resection of tumor
    Alberto Benato, Pavlos Texakalidis, Jean-Paul Wolinsky
    European Spine Journal.2025;[Epub]     CrossRef
  • Biomechanical Impact of Titanium Cage Tilt in the Sagittal Plane in Lumbar Total Spondylectomy: a Finite Element Analysis
    Ye Han, Xuehong Ren, Siyuan Wang, Liqi Luo, Yijie Liang, Shaosong Sun, Xinghai Guan, Xinying Zhang, Xiaodong Wang
    Annals of Biomedical Engineering.2025;[Epub]     CrossRef
  • Case Report: Does the misplaced titanium mesh cage after total spondylectomy causing cervicothoracic cord compression need to be removed during revision surgery?
    Xin Wang, XiaoFei Cheng, Jie Zhao, ChangQing Zhao
    Frontiers in Surgery.2024;[Epub]     CrossRef
  • Biomechanical effects of transverse connectors on total en bloc spondylectomy of the lumbar spine: a finite element analysis
    Ye Han, Xuehong Ren, Yijie Liang, Xiaoyong Ma, Xiaodong Wang
    Journal of Orthopaedic Surgery and Research.2023;[Epub]     CrossRef
  • Revisiting En Bloc Resection Versus Piecemeal Resection for the Treatment of Giant Cell Tumor of the Spine
    Sungjoon Lee, Sun-Ho Lee, Joon Ho Yoon, Chi Heon Kim, Jin Hoon Park, Sang Hyub Lee, Chang-Hyun Lee, Seung-Jae Hyun, Sang Ryong Jeon, Ki-Jeong Kim, Eun-Sang Kim, Chun Kee Chung
    World Neurosurgery.2023; 178: e165.     CrossRef
  • 7,776 View
  • 270 Download
  • 8 Web of Science
  • 7 Crossref

Review Article

Revision Surgeries at the Index Level After Cervical Disc Arthroplasty – A Systematic Review
Andrei Fernandes Joaquim, Nathan J. Lee, K. Daniel Riew
Neurospine 2021;18(1):34-44.   Published online March 31, 2021
DOI: https://doi.org/10.14245/ns.2040454.227

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Revision Surgeries at the Index Level After Cervical Disc Arthroplasty – A Systematic Review
Neurospine. 2021;18(1):34-44.   Published online March 31, 2021
DOI: https://doi.org/10.14245/ns.2040454.227
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Revision Surgeries at the Index Level After Cervical Disc Arthroplasty – A Systematic Review
Neurospine. 2021;18(1):34-44.   Published online March 31, 2021
DOI: https://doi.org/10.14245/ns.2040454.227
Close
Objective
To perform a systematic literature review on revision surgeries at the index level after cervical disc arthroplasty (CDA) failure.
Methods
A systematic literature review was performed according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Prospective studies on patients who required a secondary surgery after CDA failure were included for analysis. The minimum follow-up for these studies was 5 years.
Results
Out of 864 studies in the original search group, a total of 20 studies were included. From a total of 4,087 patients, 161 patients required a reoperation at the index level. A total of 170 surgeries were performed, as some patients required multiple surgeries. The most common secondary procedures were anterior cervical discectomy and fusion (ACDF) (68%, N = 61) and posterior cervical fusion (15.5%, N = 14), followed by other reoperation (13.3%, N = 12). The associated outcomes for those who required a revision surgery were rarely mentioned in the included literature.
Conclusion
The long-term revision rate at the index level of failed CDA surgery was 3.9%, with a minimum 5-year follow-up. ACDF was the most commonly performed procedure to salvage a failed CDA. Some patients who required a new surgery after CDA failure may require a more extensive salvage procedure and even subsequent surgeries.

Citations

Citations to this article as recorded by  Crossref logo
  • Risk Factors for Reoperation Following Single-Level Cervical Disc Arthroplasty as Utilized in a Representative Sample of United States Clinical Practice: A Retrospective PearlDiver Study
    Paal K. Nilssen, Nakul Narendran, Ida Chen, Linda E. Kanim, Corey T. Walker, Hyun W. Bae, David L. Skaggs, Alexander Tuchman
    Global Spine Journal.2025; 15(2): 1186.     CrossRef
  • A Surgical Video Guide Demonstrating the Steps to Safely Revise an Extruded Cervical Disk Arthroplasty Implant Causing Severe Spinal Cord Compression: 2-Dimensional Operative Video
    Bryce A. Pugh, Allie L. Harbert, Michael A. Galgano
    Operative Neurosurgery.2025; 29(2): 313.     CrossRef
  • Reoperation Strategy for Failure of Cervical Disc Arthroplasty at Index and Adjacent Levels
    Chae-Gwan Kong, Jong-Beom Park
    Journal of Clinical Medicine.2025; 14(6): 2038.     CrossRef
  • Patient outcomes and surgical strategies in revision cervical arthroplasty following M6-C™ disc-related osteolysis
    Matthew Scott-Young, David Nielsen, Sukhman Riar, Evelyne Rathbone
    European Spine Journal.2025; 34(8): 3365.     CrossRef
  • Cervical Disk Arthroplasty Failure in a Patient with Klippel-Feil Syndrome
    Phillip Alexeev, Ryan Snowden
    JBJS Case Connector.2025;[Epub]     CrossRef
  • Cervical Disk Arthroplasty: Updated Considerations of an Evolving Technology
    Franziska C. S. Altorfer, Fedan Avrumova, Celeste Abjornson, Darren R. Lebl
    Journal of the American Academy of Orthopaedic Surgeons.2024; 32(23): e1205.     CrossRef
  • Cervical Disc Replacement with a Keeled Implant Causing an Intraoperative Fracture: a Case Report
    Jonathon Garrett, Michael McDermott, Joseph Mixa, Michael Rogers, Rebecca Michna, Robert Prior, Ashish Patel
    Journal of the American Osteopathic Academy of Orthopedics.2024;[Epub]     CrossRef
  • Observational, Multicenter Study of the Efficacy and Safety of Cervical Disk Arthroplasty With Mobi-C in the Treatment of Cervical Degenerative Disk Disease. Results at 10 years Follow-Up
    Jean-Paul Steib, Thierry Dufour, Jacques Beaurain, Pierre Bernard, Jean Huppert
    Spine.2023; 48(7): 452.     CrossRef
  • Clinical Effectiveness of Artificial Disc Replacement in Comparison With Anterior Cervical Discectomy and Fusion in the Patients With Cervical Myelopathy: Systematic Review and Meta-analysis
    Jung Hwan Lee, Youn Joo Lee, Min Cheol Chang, Jun Ho Lee
    Neurospine.2023; 20(3): 1047.     CrossRef
  • Impact of Posterior Cervical Foraminotomy Before or After Cervical Disk Replacement
    Mason W. Young, Amir M. Abtahi
    Clinical Spine Surgery.2023; 36(9): 391.     CrossRef
  • Revision Strategies for Cervical Disc Arthroplasty
    Steven G. Roth, Marcos Joaquin Robles Ortiz, Meghana Vulapalli, K. Daniel Riew
    Clinical Spine Surgery.2023; 36(9): 411.     CrossRef
  • Comparable long-term outcomes in patients undergoing total disc replacement or anterior cervical discectomy and noninstrumented fusion
    Tuomas Hirvonen, Mathias Hämäläinen, Juho Konsti, Jussi Antinheimo, Jussi Numminen, Jari Siironen, Anniina Koski-Palkén, Mika Niemelä
    The Spine Journal.2023; 23(12): 1817.     CrossRef
  • Enhanced Intervertebral Disc Repair via Genetically Engineered Mesenchymal Stem Cells with Tetracycline Regulatory System
    Yeji Kim, Seong Bae An, Sang-Hyuk Lee, Jong Joo Lee, Sung Bum Kim, Jae-Cheul Ahn, Dong-Youn Hwang, Inbo Han
    International Journal of Molecular Sciences.2023; 24(22): 16024.     CrossRef
  • Safety and Feasibility of Intradiscal Administration of Matrilin-3-Primed Adipose-Derived Mesenchymal Stromal Cell Spheroids for Chronic Discogenic Low Back Pain: Phase 1 Clinical Trial
    Dong Hyun Lee, Kwang-Sook Park, Hae Eun Shin, Sung Bum Kim, Hyejeong Choi, Seong Bae An, Hyemin Choi, Joo Pyung Kim, Inbo Han
    International Journal of Molecular Sciences.2023; 24(23): 16827.     CrossRef
  • Combining Virtual Surgical Planning and Patient-Specific 3D-Printing as a Solution to Complex Spinal Revision Surgery
    David A. M. Tredan, Ralph J. Mobbs, Monish Maharaj, William C. H. Parr
    Journal of Personalized Medicine.2022; 13(1): 19.     CrossRef
  • Cervical Radiculopathy: Focus on Factors for Better Surgical Outcomes and Operative Techniques
    Kyung-Chung Kang, Tae Su Jang, Cheol Hyun Jung
    Asian Spine Journal.2022; 16(6): 995.     CrossRef
  • The Effect of Subsidence on Segmental and Global Lordosis at Long-term Follow-up After Anterior Cervical Discectomy and Fusion
    Akiro H. Duey, Christopher Gonzalez, Eric A. Geng, Pierce J. Ferriter Jr, Ashley M. Rosenberg, Ula N. Isleem, Bashar Zaidat, Paul M. Al-Attar, Jonathan S. Markowitz, Jun S. Kim, Samuel K. Cho
    Neurospine.2022; 19(4): 927.     CrossRef
  • 13,296 View
  • 271 Download
  • 17 Web of Science
  • 17 Crossref

Original Article

Synthetic Cages Associated With Increased Rates of Revision Surgery and Higher Costs Compared to Allograft in ACDF in the Nonelderly Patient
Majd Marrache, Rachel Bronheim, Andrew B. Harris, Varun Puvanesarajah, Micheal Raad, Sang Lee, Richard Skolasky, Amit Jain
Neurospine 2020;17(4):896-901.   Published online December 31, 2020
DOI: https://doi.org/10.14245/ns.2040216.108

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Synthetic Cages Associated With Increased Rates of Revision Surgery and Higher Costs Compared to Allograft in ACDF in the Nonelderly Patient
Neurospine. 2020;17(4):896-901.   Published online December 31, 2020
DOI: https://doi.org/10.14245/ns.2040216.108
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Synthetic Cages Associated With Increased Rates of Revision Surgery and Higher Costs Compared to Allograft in ACDF in the Nonelderly Patient
Neurospine. 2020;17(4):896-901.   Published online December 31, 2020
DOI: https://doi.org/10.14245/ns.2040216.108
Close
Objective
The aim of this study was to compare all-cause reoperation rates and costs in nonelderly patients treated with anterior cervical discectomy and fusion (ACDF) with structural allograft versus synthetic cages for degenerative pathology.
Methods
We queried a private claims database to identify adult patients ( ≤ 65 years) who underwent single-level ACDF in a hospital setting using either structural allograft or a synthetic cage (polyetheretherketone, metal, or hybrid device), from 2010 to 2016. The rate of all-cause reoperations at 2 years were compared between the 2 groups. Index hospitalization costs and 90-day complication rates were also compared. Significance was set at p < 0.05.
Results
A total of 26,754 patients were included in the study. 11,514 patients (43%) underwent ACDF with structural allograft and 15,240 (57%) underwent ACDF with a synthetic cage. The patients in the allograft group were younger and more likely to be male. There was no significant difference between the 2 groups with respect to 90-day complications including: wound dehiscence, dysphagia, dysphonia, and hematoma/seroma. In the 2-year postoperative period, the synthetic cage group had a significantly higher rate of allcause reoperation compared to the allograft group (9.1% vs. 8.0%, p = 0.002). Index hospitalization costs were significantly higher in the synthetic cage group compared to those in the allograft group ($23,475 vs. $20,836, p < 0.001).
Conclusion
Structural allograft is associated with lower all-cause reoperation rates and lower index costs in nonelderly patients undergoing ACDF surgery for degenerative pathology. It is important to understand this data as we transition toward value-based care.

Citations

Citations to this article as recorded by  Crossref logo
  • Revision Surgery after Single Level Anterior Cervical Discectomy and Fusion With Plate vs Stand-Alone Cage over 2 to 5 Year Follow-Up
    Wesley M. Durand, Rajan Khanna, Gabriel I. Nazario-Ferrer, Sang H. Lee, Richard L. Skolasky, Amit Jain
    Global Spine Journal.2025; 15(4): 2014.     CrossRef
  • Considering the Effects of Age and Patient Factors on Subsidence and Implant Selection in Anterior Cervical Discectomy and Fusion
    Jeffrey B. Weinreb, Jake Carbone, Hershil Patel, Amit Ratanpal, Rohan I. Suresh, Tyler J. Pease, Ryan A. Smith, Joseph Blommer, Anthony K. Chiu, Idris Amin, Louis J. Bivona, Julio J. Jauregui, Daniel L. Cavanaugh, Eugene Y. Koh, Charles A. Sansur, Steven
    Clinical Spine Surgery.2025;[Epub]     CrossRef
  • Reoperation Rate Following Single-Level Anterior Cervical Discectomy and Fusion With Standalone Cage Versus Anterior Plating in a Large Matched Cohort
    Adeesya Gausper, Andrew M. Miller, Vivien Chan, Suhas K. Etigunta, Andy M. Liu, David Skaggs, Tiffany Perry, Corey Walker, Alexander Tuchman
    Clinical Spine Surgery.2025;[Epub]     CrossRef
  • Anterior Cervical Discectomy and Fusion With Structural Allograft is Associated With Lower Postoperative Health Care Utilization and Reoperations Compared With Cage Implants
    Andrew Y. Powers, Darren Z. Nin, Ya-Wen Chen, Ruijia Niu, David H. Kim, David C. Chang, Raymond W. Hwang
    Operative Neurosurgery.2024; 26(1): 16.     CrossRef
  • Anterior cervical decompression and fusion at one and two levels: trends and factors associated with structural allograft versus synthetic cages
    Lucas Kim, Jonathan N. Grauer
    North American Spine Society Journal (NASSJ).2024; 17: 100310.     CrossRef
  • Clinical and radiological outcomes of non-window-type bioactive glass–ceramic cage in single-level ACDF versus PEEK cage filled with autologous bone
    Ji-Won Kwon, Yong Ho Lee, Byung Ho Lee, Jae Hong Kim, Kyung Soo Suk
    Scientific Reports.2024;[Epub]     CrossRef
  • Structural Allograft versus Polyetheretherketone Cage in Anterior Cervical Discectomy and Fusion: A Meta-Analysis
    Tu Thai Bao Nguyen, Nguyen Anh Duy Tran, Huu Dat Nguyen, Khai Duy Lam, Thanh Tan Nguyen, Yi-Jie Kuo, Yu-Pin Chen
    World Neurosurgery.2024; 191: e730.     CrossRef
  • A Five-Year Cost-Utility Analysis Comparing Synthetic Cage Versus Allograft Use in Anterior Cervical Discectomy and Fusion Surgery for Cervical Spondylotic Myelopathy
    Micheal Raad, Amy L. Xu, Carlos Ortiz-Babilonia, Majd Marrache, Wesley M. Durand, Marc Greenberg, Amit Jain
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    Asian Spine Journal.2023; 17(4): 620.     CrossRef
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    Hyun Jun Jang, Kyung Hyun Kim, Jeong Yoon Park, Keun Su Kim, Yong Eun Cho, Dong Kyu Chin
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    Akiro H. Duey, Christopher Gonzalez, Eric A. Geng, Pierce J. Ferriter Jr, Ashley M. Rosenberg, Ula N. Isleem, Bashar Zaidat, Paul M. Al-Attar, Jonathan S. Markowitz, Jun S. Kim, Samuel K. Cho
    Neurospine.2022; 19(4): 927.     CrossRef
  • 8,316 View
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Case Report: Technical Note

The Technical Feasibility of Unilateral Biportal Endoscopic Decompression for The Unpredicted Complication Following Minimally Invasive Transforaminal Lumbar Interbody Fusion: Case Report
Kwang-Ryeol Kim, Jeong-Yoon Park
Neurospine 2020;17(Suppl 1):S154-S159.   Published online July 31, 2020
DOI: https://doi.org/10.14245/ns.2040174.087

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The Technical Feasibility of Unilateral Biportal Endoscopic Decompression for The Unpredicted Complication Following Minimally Invasive Transforaminal Lumbar Interbody Fusion: Case Report
Neurospine. 2020;17(Suppl 1):S154-S159.   Published online July 31, 2020
DOI: https://doi.org/10.14245/ns.2040174.087
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The Technical Feasibility of Unilateral Biportal Endoscopic Decompression for The Unpredicted Complication Following Minimally Invasive Transforaminal Lumbar Interbody Fusion: Case Report
Neurospine. 2020;17(Suppl 1):S154-S159.   Published online July 31, 2020
DOI: https://doi.org/10.14245/ns.2040174.087
Close
Minimally invasive techniques for transforaminal lumbar interbody fusion (MIS-TLIF) are advantageous because they allow for sufficient surgical exposure and fewer complications through a smaller incision than conventional TLIF. It could be difficult to maintain minimally invasive spine surgery following the unexpected complications after MIS-TLIF. Because MIS-TLIF is usually done via a paramedian small incision with posterior fusion using screws and rods, visualization of the surgical field is limited, and it is difficult to directly assess the neural structure without removing instrumentation. Unilateral biportal endoscopic decompression (UBE) is a rapidly growing surgical method using two 1-cm incisions that are 2 to 3 cm apart. We would like to suggest UBE as an option for immediate reoperation after MIS-TLIF because it has the advantages of targeting pathologic regions and a wide field of visualization through small wounds. The operation is independent of the existing incision from MIS-TLIF, enabling immediate revision surgery without the removal of the screws and rods. UBE has the advantages of targeting specific surgical regions and providing a wide visualization of the operation field through small incisions. UBE can be very useful for discectomy or decompression surgery as well as in immediate reoperation after MIS-TLIF.

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    Liwen Feng, Junbo Liang, Naiguo Wang, Qingyu Zhang
    Therapeutics and Clinical Risk Management.2024; Volume 20: 249.     CrossRef
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    Neurospine.2023; 20(1): 56.     CrossRef
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    Jae-Young So, Jeong-Yoon Park
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    Frontiers in Surgery.2022;[Epub]     CrossRef
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    Neurospine.2021; 18(4): 871.     CrossRef
  • 10,561 View
  • 305 Download
  • 22 Web of Science
  • 22 Crossref

Clinical Article

Variation of C-Reactive Protein and White Blood Cell Counts in Spinal Operation: Primary Fusion Surgery Versus Revision Fusion Surgery
Kyung Tag Kang, Dong Wuk Son, Su Hun Lee, Geun Seong Song, Soon Ki Sung, Sang Weon Lee
Korean J Spine 2017;14(3):66-70.   Published online September 30, 2017
DOI: https://doi.org/10.14245/kjs.2017.14.3.66

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Variation of C-Reactive Protein and White Blood Cell Counts in Spinal Operation: Primary Fusion Surgery Versus Revision Fusion Surgery
Korean J Spine. 2017;14(3):66-70.   Published online September 30, 2017
DOI: https://doi.org/10.14245/kjs.2017.14.3.66
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Variation of C-Reactive Protein and White Blood Cell Counts in Spinal Operation: Primary Fusion Surgery Versus Revision Fusion Surgery
Korean J Spine. 2017;14(3):66-70.   Published online September 30, 2017
DOI: https://doi.org/10.14245/kjs.2017.14.3.66
Close
Objective:
Serum C-reactive protein(CRP) concentrations and white blood cell(WBC) count are commonly used to identify postoperative wound infections. We investigated whether changes in serum CRP levels and WBC counts actually differed between patients undergoing revision spinal fusion surgery and those undergoing a primary fusion. Methods: Patients who underwent posterolateral fusion(PLF) surgery at Pusan National University Yangsan Hospital between October 2013 and April 2015 were considered for this study. Sixty-seven patients with primary lumbar PLF(pPLF) and 21 with revision PLF(rPLF) were enrolled. A retrospective assessment of preoperative and postoperative CRP levels and WBC count was undertaken. Also, we gathered peak CRP day, and CRP normalization days. Comorbidity data were also obtained to evaluate any effects on the course of CRP and WBC count postoperatively. Results: CRP levels peaked at 3 days after surgery. The maximum CRP values recorded for each group: 4.17(standard deviation[SD], 4.18)mg/dL and 4.88(SD, 3.03)mg/dL for pPLF and rPLF. This difference was not statistically significant(p=0.24). A rapid fall in CRP within 5-9 days was observed for both groups. Conclusion: Out of our expectation, changes in CRP levels after spinal fusion surgery follow the same course regardless of whether it is a revision operation or not. Because of this result, both the primary PLF surgery and revision PLF surgery should be monitored using CRP in the similar way and the antibiotic administration should be determined.

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    Hiroyuki Aono, Shota Takenaka, Yukitaka Nagamoto, Hidekazu Tobimatsu, Tomoya Yamashita, Masayuki Furuya, Hiroyuki Ishiguro, Motoki Iwasaki
    World Neurosurgery.2025; 196: 123681.     CrossRef
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    Frontiers in Medicine.2025;[Epub]     CrossRef
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    D. O. Kovalenko, M. O. Malyuk
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    Petr Domecky, Anna Rejman Patkova, Katerina Mala-Ladova, Josef Maly
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    Yehia Elbromboly, Mohamed Abdallah Esawy
    Journal of Orthopaedic Surgery and Research.2023;[Epub]     CrossRef
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    Bu Kwang Oh, Dong Wuk Son, Su Hun Lee, Jun Seok Lee, Soon Ki Sung, Sang Weon Lee, Geun Sung Song
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    Aysel Gökçek, Kemal Gökçek, Murat Biteker
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    Young Lee, Jeongwook Lim, Seung-Won Choi, Sanghyun Han, Bumsoo Park, Jin-Young Youm
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    Chao-Jun Shen, Tao Miao, Zhang-Fu Wang, Zhen-Fa Li, Ling-Qin Huang, Ting-Ting Chen, Wei-Hua Yan
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    Mikinobu Takeuchi
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    Paul Bosch, Janna van den, Joost D.J. Plate, Frank F.A. IJpma, R. Marijn Houwert, Albert Huisman, Falco Hietbrink, Luke P.H. Leenen, Geertje A.M. Govaert
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  • 145 Download
  • 11 Crossref

Technical Note

Application of Lateral Approach for the Removal of Migrated Interbody Cage: Taphole and Fixing Technique
Jae Sung Eom, Ikchan Jeon, Sang Woo Kim
Korean J Spine 2017;14(1):23-26.   Published online March 31, 2017
DOI: https://doi.org/10.14245/kjs.2017.14.1.23

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Application of Lateral Approach for the Removal of Migrated Interbody Cage: Taphole and Fixing Technique
Korean J Spine. 2017;14(1):23-26.   Published online March 31, 2017
DOI: https://doi.org/10.14245/kjs.2017.14.1.23
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Application of Lateral Approach for the Removal of Migrated Interbody Cage: Taphole and Fixing Technique
Korean J Spine. 2017;14(1):23-26.   Published online March 31, 2017
DOI: https://doi.org/10.14245/kjs.2017.14.1.23
Close
When a revision surgery related with removal of failed interbody cage is required, going through the previous passage can lead to a higher risk of neurological deficits or incidental dural injuries. Recently, the lateral approach has become a popular method instead of the conventional anterior or posterior approaches. The lateral approach is also useful method to remove failed interbody cage previously placed and re-do interbody fusion with lower risks compared to revision surgery via previous passage. However, there is still some difficulty in retrieving the interbody cage from the intervertebral space because of no spacious passage, subsidence, and uncontrolled movable cage. In this study, we introduce our experience that we removed failed interbody cage more easily with only the simple additional steps of making a taphole and fixing the cage using a thread-tipped stick.

Citations

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    Weiming Zhao, Shuxin Zheng, Yawen Su, Xi Yang, Chunguang Zhou, Yueming Song
    BMC Musculoskeletal Disorders.2026;[Epub]     CrossRef
  • The role of XLIF in spinal revision surgery involving failed interbody implants: a review of technique, outcomes, and indications
    Yusuf-Zain Ansari, Arwa Jader, Abdul Hameed Kidwai, Dia R. Halalmeh
    Acta Neurochirurgica.2025;[Epub]     CrossRef
  • Intraoperative Anteropulsion of an Interbody Fusion Cage During Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Case Report
    Ameya Rangnekar, Ayush Sharma, Atif Naseem, Harsh Agrawal, Komalchand Gajbhiye, Nandan Marathe
    Journal of Minimally Invasive Spine Surgery and Technique.2023; 8(2): 224.     CrossRef
  • Using an Extreme Lateral Interbody Fusion (XLIF) in Revising Failed Transforaminal Lumbar Interbody Fusion (TLIF) With Exchange of Cage
    Anwar M Al-Rabiah, Zahraa I Alghafli, Ibrahim Almazrua
    Cureus.2021;[Epub]     CrossRef
  • Delayed asymptomatic retroperitoneal dislodgement into the pouch of Douglas of a TLIF cage: A case report and review of the literature
    Manoj Kumar, Deepak Kaucha, Nitin Adsul, R. S. Chahal, K. L. Kalra, Shankar Acharya
    Surgical Neurology International.2021; 12: 360.     CrossRef
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    Peter B. Derman, Kern Singh
    HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery.2020; 16(2): 183.     CrossRef
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    M. Burhan Janjua, Nissim Ackshota, Vincent Arlet
    Spine Deformity.2019; 7(4): 633.     CrossRef
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    Saurav Narayan Nanda, Mantu Jain, Sudarsan Behera, Manisha Gaikwad
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  • 174 Download
  • 8 Crossref

Clinical Articles

Predictors of Reoperation after Microdecompression in Lumbar Spinal Stenosis
Hee-Jong Hwang, Hyung-Ki Park, Gwang-Soo Lee, June-Young Heo, Jae-Chil Chang
Korean J Spine 2016;13(4):183-189.   Published online December 31, 2016
DOI: https://doi.org/10.14245/kjs.2016.13.4.183

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Predictors of Reoperation after Microdecompression in Lumbar Spinal Stenosis
Korean J Spine. 2016;13(4):183-189.   Published online December 31, 2016
DOI: https://doi.org/10.14245/kjs.2016.13.4.183
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Predictors of Reoperation after Microdecompression in Lumbar Spinal Stenosis
Korean J Spine. 2016;13(4):183-189.   Published online December 31, 2016
DOI: https://doi.org/10.14245/kjs.2016.13.4.183
Close
Objective

The risk factors of reoperation after microdecompression (MD) for lumbar spinal stenosis (LSS) are unclear. In this study, we presented the outcomes of MD for degenerative LSS and investigated the risk factors associated with reoperation.

Methods

A retrospective review was conducted using the clinical records and radiographs of patients with LSS who underwent MD. For clinical evaluation, we used the Japanese Orthopedic Association (JOA) scoring system for low back pain, body mass index, and Charlson comorbidity index. For radiological evaluation, disc height, facet angle, and sagittal rotation angle were measured in operated segments. Also the Modic change and Pfirrmann grade for degeneration in the endplate and disc were scored.

Results

Forty-three patients aged 69±9 years at index surgery were followed for 48±25 months. The average preoperative JOA score was 6.9±1.6 points. The score improved to 9.1±2.1 points at the latest follow-up (p<0.001). Seven patients (16.3%) underwent reoperation. Clinical and radiological factors except operation level and Pfirrmann grade showed a p-value >0.1. Patients with Pfirrmann grade IV and lower lumbar segment had a 29.1% rate of reoperation (p=0.001), whereas patients without these factors had a 0% rate of reoperation.

Conclusion

Moderate disk degeneration (Pfirrmann IV) in lower lumbar segments is a risk factor of disk herniation or foraminal stenosis requiring reoperation after MD in LSS.

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    Jun Jae Shin, Keonhee Kim, Se Jun Park, Won Joo Jeong, Sun Joon Yoo, Dong Ah Shin, Joongkyum Shin, Hyun Jun Jang, Dong Kyu Chin
    Yonsei Medical Journal.2026; 67(3): 269.     CrossRef
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    Xu Li, Yongjin Sun, Guolin Tang, Buzhou Chen, Wenzhi Zhang
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    Di Zhang, Jiawei Du, Jiaxiao Shi, Yundong Zhang, Siyue Jia, Xingyu Liu, Yu Wu, Yicheng An, Shibo Zhu, Dayu Pan, Wei Zhang, Yiling Zhang, Shiqing Feng
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    Omar H. Tarawneh, Rajkishen Narayanan, Delano Trenchfield, Yunsoo Lee, Tariq Z. Issa, Yoni Dulitzki, Bahram Pashaee, Krisna Maddy, Hannah Bash, Gokul Karthikeyan, lan David Kaye, John J. Mangan, Jose A. Canseco, Alan S. Hilibrand, Alexander R. Vaccaro, Ch
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    Garrett Bullock, Christian A. Sangio, Edward C. Beck, Anirudh K. Gowd, Evan Miller, Kerry Danelson, Tadhg James O’Gara
    Spine.2023; 48(5): 350.     CrossRef
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    Dimitris Dimitriou, Elin Winkler, Sabrina Weber, Samuel Haupt, Michael Betz, Mazda Farshad
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    Anna-Katharina Calek, Franziska Altorfer, Marie-Rosa Fasser, Jonas Widmer, Mazda Farshad
    European Spine Journal.2023; 32(9): 3183.     CrossRef
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    Joanna Baranowska-Kijewska, Paweł Baranowski, Alicja Baranowska, Tobiasz Jarzyński, Marek Rybarczyk
    Archives of Medical Science.2023; 19(4): 1154.     CrossRef
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    Hee Jung Son, Bong-Soon Chang, Sam Yeol Chang, Geunwu Gimm, Hyoungmin Kim
    Clinics in Orthopedic Surgery.2023; 15(5): 800.     CrossRef
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    Jørn Aaen, Ivar Magne Austevoll, Christian Hellum, Kjersti Storheim, Tor Åge Myklebust, Hasan Banitalebi, Masoud Anvar, Jens Ivar Brox, Clemens Weber, Tore Solberg, Oliver Grundnes, Helena Brisby, Kari Indrekvam, Erland Hermansen
    European Spine Journal.2022; 31(6): 1391.     CrossRef
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    Lantao Liu, Jian Dong, Dechun Wang, Chao Zhang, Yue Zhou
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Minimally Invasive Extraforaminal Lumbar Interbody Fusion for Revision Surgery: A Technique through Kambin's Triangle
Jun Gue Lee, Hyeun Sung Kim, Seok Won Kim
Korean J Spine 2015;12(4):267-271.   Published online December 31, 2015
DOI: https://doi.org/10.14245/kjs.2015.12.4.267

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Minimally Invasive Extraforaminal Lumbar Interbody Fusion for Revision Surgery: A Technique through Kambin's Triangle
Korean J Spine. 2015;12(4):267-271.   Published online December 31, 2015
DOI: https://doi.org/10.14245/kjs.2015.12.4.267
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Minimally Invasive Extraforaminal Lumbar Interbody Fusion for Revision Surgery: A Technique through Kambin's Triangle
Korean J Spine. 2015;12(4):267-271.   Published online December 31, 2015
DOI: https://doi.org/10.14245/kjs.2015.12.4.267
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Objective

The purpose of this study was to evaluate the clinical outcomes of minimally invasive extraforaminal lumbar interbody fusion (ELIF) for revision surgery.

Methods

From January 2011 to December 2012, 12 patients who underwent minimally invasive ELIF through the Kambin's triangle for revision surgery were included in this study. All patients underwent the surgical procedure in the following sequence: (1) epidural anesthesia, (2) exposing the Kambin's triangle toward the lateral part of the dura (partial resection of the superior articular process), (3) bilateral cage insertion for reinforcement of stabilization and fusion, and (4) percutaneous transpedicular screwing. Clinical outcomes were assessed using the visual analogue scale (VAS), and Oswestry disability index (ODI). Imaging and clinical findings including surgical techniques, clinical outcomes, and related complications were depicted and analyzed.

Results

The mean age of the patients (5 men, 7 women) was 60.7±13.4 years, and the mean follow-up period was 27.1±4.9 months. The mean VAS (back and leg) score improved significantly at final follow-up. The mean ODI score decreased as follows: preoperative, 76.78±6.08; 3 months after the surgery, 37.74±6.67; and at final follow-up, 29.91±2.98. Two patients presented with transient nerve root irritation, but there were no cases of incidental dural tear or serious infection. No significant neurological deterioration or major complication was noted in any of the patients.

Conclusion

Minimally invasive ELIF for revision surgery is an effective surgical option with a low complication rate.

Citations

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  • Complication Risk in Primary and Revision Minimally Invasive Lumbar Interbody Fusion: A Comparable Alternative to Conventional Open Techniques?
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  • Nerve Root and Lumbar Plexus Proximity to Different Extraforaminal Lumbar Interbody Fusion Trajectories
    Abhishek Kumar, Robert K. Merrill, Sheeraz A. Qureshi
    Clinical Spine Surgery: A Spine Publication.2017; 30(10): E1382.     CrossRef
  • 10,924 View
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