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67th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Korean Neurosurgical Society (KNS)

German Society of Neurosurgery (DGNC)

12 - 15 June 2016, Frankfurt am Main

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The selection of open or percutaneous endoscopic lumbar diskectomy according to an age cut-off point: national-wide cohort study

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  • Chi Heon Kim - Seoul National University Hospital
  • Chun Kee Chung - Seoul National University Hospital
  • Jeong Hyun Moon - Seoul National University Hospital

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocP 067

doi: 10.3205/16dgnc442, urn:nbn:de:0183-16dgnc4425

Published: June 8, 2016

© 2016 Kim et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Open discectomy is the standard operation for lumbar herniated intervertebral disk disease (HIVD). PELD have shown not-inferior outcome to open discectomy and the interest on the PELD seems to be increasing. However, PELD may not be an applicable option for all ages. The object of the present study was to provide an age cut-off of percutaneous endoscopic lumbar discectomy (PELD) for optimal reoperation rate with national-based population based data.

Method: We selected 15,817 patients who underwent open discectomy (n = 12,816) or PELD (n = 3,001) in 2003 from Korean Health Insurance Review & Assessment Service (HIRA) database. All patients in the cohort were followed until December 31, 2008, and the minimum follow-up period was 5 years. A time to event survival analysis was performed. Primary end-point was any type of second lumbar spine surgery during the follow-up period. Minimum P-value approach and two-fold cross validation approach were utilized to determine an age cut-off point.

Results: The optimal age cut-off point was determined as 57 years. PELD for elder patients (= 57 years) had a higher reoperation risk during postoperative 3.4 years (Hazard ratio [HR] at 1 yr, 1.75; 2 yr, 1.57; 3 yr, 1.41). However, re-operation risk was not higher after PELD for patients of < 57 years from 1.9 years than open discectomy (HR at 2 yr, 0.86; 3 yr, 0.78; 4 yr, 0.70; 5 yr, 0.63).

Conclusions: In the present study, we showed that an age cut-off point of PELD for optimal reoperation rate may be 57 years with national-wide population based data. Reoperation rate seems to be not higher for patients younger than 57 years after PELD than open discectomy, but applying PELD for elder patients need careful consideration.