Risk Assessment for Reoperation After Surgery for Lumbar Degenerative Disease Based on Preoperative Clinical Characteristics and Imaging Parameters: A Retrospective Cohort Study

AIM: To explore the relevant clinical and radiological risk factors for reoperation in patients with lumbar degenerative diseases, and to inform preoperative risk stratification. METHODS: This was a single-center retrospective cohort study. A total of 653 patients with lumbar degenerative diseases who underwent initial surgical treatment at Nanchang Hongdu Hospital of Traditional Chinese Medicine Affiliated to Jiangxi University of Chinese Medicine between June 2018 and June 2022 were included. All patients completed a 36-month follow-up. Demographic characteristics, comorbidities, perioperative parameters, and preoperative imaging parameters were collected, including the degree of intervertebral disc degeneration (Pfirrmann classification), the degree of paraspinal muscle fat infiltration (Goutallier classification), facet joint effusion distribution, and facet joint angles. Patients were divided into a reoperation group (n = 41) and a non-reoperation group (n = 612) based on whether they underwent reoperation for complications related to the index surgical segment during the follow-up period. Univariate and multivariable logistic regression analyses were performed to identify independent factors associated with postoperative reoperation, and their discriminative ability was evaluated using receiver operating characteristic (ROC) curves. RESULTS: The reoperation rate within 36 months postoperatively was 6.28% (41/653). Final multivariable logistic regression analysis showed that age (Odds Ratio [OR] = 1.11, 95% Confidence Interval [CI] 1.06~1.15, p < 0.001), preoperative visual analog scale (VAS) score (OR = 1.82, 95% CI 1.48~2.23, p < 0.001), and Pfirrmann grade 5 (OR = 3.52, 95% CI 1.51~8.21, p = 0.004) were independent risk factors for reoperation. Compared with patients with bilateral effusion or synovial cysts, patients with unilateral effusion had a significantly lower risk of reoperation (OR = 0.03, 95% CI 0.00~0.23, p < 0.001). The area under the ROC curve for the combination of these factors was 0.89 (0.84–0.94), with a sensitivity of 78.0% and a specificity of 86.0%. CONCLUSIONS: Age, preoperative pain level, intervertebral disc degeneration grade, and facet joint effusion status (bilateral effusion or synovial cyst vs. unilateral effusion) may be closely related to the risk of reoperation after lumbar degenerative disease surgery. Patients with these characteristics should be thoroughly evaluated preoperatively to inform the development of individualized treatment strategies.