Introduction. Due to co-morbidities in elderly like atherosclerosis and approach-related risks, anterior lumbar surgery is mainly recommended for younger patients. We reviewed approach-related complications in anterior lumbar surgery in senior patients for complex reconstructions. Materials and Methods. Retrospective review of 12 patients (8 female and 4 male), mean age 65.5±4.9 years, treated with anterior fusion mainly for degenerative scoliosis and lumbar kyphosis in between 2007-10. 9(75%) patients had multilevel procedures. Most common co-morbidities were atherosclerosis (CT-proven in 7 patients), coronary heart disease and COPD. Renal impairment was present preoperatively in 3 patients. Results. Mean duration of surgery was 260±120.8 min and mean blood loss 403.3±348.0 ml in the whole group (157±49.1 min and 240.0±162.0 ml in single ALIF; 334.0±100.0 min and 520.0±408.0 ml in multilevel procedures). Retractor related ischaemia occurred in 8 patients (27.3±29.1 min); perfusion of the leg returned immediately after release (confirmed via pulse-oxymetry). 2 patients had a direct vessel suture (2 common iliac veins); hypotension during surgery occurred in 1 patient due to anaesthetic problems. 5 patients needed ICU support after the procedure. Superficial wound infection was reported in one patient. One case of incisional hernia and one case of lymphocele was noticed. Conclusion. In this retrospective review, no specific complications concerning age or co-morbidities occurred in senior patients. In this group, atherosclerosis was the most common co-morbidity. However, no arterial embolism or perfusion deficit occurred. In the future, more and more elderly are to be treated by spinal surgeons. Anterior lumbar surgery is an alternative treatment option even for complex cases in the elderly. This limited group of patients need further investigations and prospective studies regarding anterior lumbar surgery

There have been a few reports of patients with a combination of lumbar and thoracic spinal stenosis. We describe six patients who suffered unexpected acute neurological deterioration at a mean of 7.8 days (6 to 10) after lumbar decompressive surgery. Five had progressive weakness and one had recurrent pain in the lower limbs. There was incomplete recovery following subsequent thoracic decompressive surgery. The neurological presentation can be confusing. Patients with compressive myelopathy due to lower thoracic lesions, especially epiconus lesions (T10 to T12/L1 disc level), present with similar symptoms to those with lumbar radiculopathy or cauda equina lesions. Despite the rarity of this condition we advise that patients who undergo lumbar decompressive surgery for stenosis should have sagittal whole spine MRI studies pre-operatively to exclude proximal neurological compression. Cite this article: Bone Joint J 2013;95-B:1388–91

Aims

Our aim was to perform a systematic review of the literature to assess the incidence of post-operative epidural haematomas and wound infections after one-, or two-level, non-complex, lumbar surgery for degenerative disease in patients with, or without post-operative wound drainage.

Aims. People with severe, persistent low back pain (LBP) may be offered lumbar spine fusion surgery if they have had insufficient benefit from recommended non-surgical treatments. However, National Institute for Health and Care Excellence (NICE) 2016 guidelines recommended not offering spinal fusion surgery for adults with LBP, except as part of a randomized clinical trial. This survey aims to describe UK clinicians’ views about the suitability of patients for such a future trial, along with their views regarding equipoise for randomizing patients in a future clinical trial comparing lumbar spine fusion surgery to best conservative care (BCC; the FORENSIC-UK trial). Methods. An online cross-sectional survey was piloted by the multidisciplinary research team, then shared with clinical professional groups in the UK who are involved in the management of adults with severe, persistent LBP. The survey had seven sections that covered the demographic details of the clinician, five hypothetical case vignettes of patients with varying presentations, a series of questions regarding the preferred management, and whether or not each clinician would be willing to recruit the example patients into future clinical trials. Results. There were 72 respondents, with a response rate of 9.0%. They comprised 39 orthopaedic spine surgeons, 17 neurosurgeons, one pain specialist, and 15 allied health professionals. Most respondents (n = 61,84.7%) chose conservative care as their first-choice management option for all five case vignettes. Over 50% of respondents reported willingness to randomize three of the five cases to either surgery or BCC, indicating a willingness to participate in the future randomized trial. From the respondents, transforaminal interbody fusion was the preferred approach for spinal fusion (n = 19, 36.4%), and the preferred method of BCC was a combined programme of physical and psychological therapy (n = 35, 48.5%). Conclusion. This survey demonstrates that there is uncertainty about the role of lumbar spine fusion surgery and BCC for a range of example patients with severe, persistent LBP in the UK. Cite this article: Bone Jt Open 2024;5(7):612–620

Aims

The aim of this study was to determine the influence of developmental spinal stenosis (DSS) on the risk of re-operation at an adjacent level.

We compared a group of 46 somatised patients with a control group of 41 non-somatised patients who had undergone elective surgery to the lumbar spine in an attempt to identify pre-operative factors which could predict the outcome. In a prospective single-centre study, the Distress and Risk Assessment method consisting of a modified somatic perception questionnaire and modified Zung depression index was used pre-operatively to identify somatised patients. The type and number of consultations were correlated with functional indicators of outcome, such as the Oswestry disability index and a visual analogue score for pain in the leg after follow-up for six and 12 months.

Similar improvements in the Oswestry disability index were found in the somatised and non-somatised groups. Somatised patients who had a good outcome on the Oswestry disability index had an increased number of orthopaedic consultations (50 of 83 patients (60%) vs 29 of 73 patients (39.7%); p = 0.16) and waited less time for their surgery (5.5 months) (sd 5.26) vs 10.1 months (sd 6.29); p = 0.026). No other identifiable factors were found. A shorter wait for surgery appeared to predict a good outcome. Early review by a spinal surgeon and a reduced waiting time to surgery appear to be of particular benefit to somatised patients.

Background and Purpose. The UK's NIHR and Australia's NHMRC have funded two randomised controlled trials (RCTs) to determine if lumbar fusion surgery (LFS) is more effective than best conservative care (BCC) for adults with persistent, severe low back pain (LBP) attributable to lumbar spine degeneration. We aimed to describe clinicians’ decision-making regarding suitability of patient cases for LFS or BCC and level of equipoise to randomise participants in the RCTs. Methods. Two online cross-sectional surveys distributed via UK and Australian professional networks to clinicians involved in LBP care, collected data on clinical discipline, practice setting and preferred care of five patient cases (ranging in age, pain duration, BMI, imaging findings, neurological signs/symptoms). Clinicians were also asked about willingness to randomise each patient case. Results. Of 174 responses (73 UK, 101 Australia), 70 were orthopaedic surgeons, 34 neurosurgeons, 65 allied health professionals (AHPs), 5 others. Most worked in public health services only (92% UK, 45% Australia), or a mix of public/private (36% Australia). Most respondents chose BCC as their first-choice management option for all five cases (81–93% UK, 83–91% Australia). For LFS, UK surgeons preferred TLIF (36.4%), whereas Australian surgeons preferred ALIF (54%). Willingness to randomise cases ranged from 37–60% (UK mean 50.7%), and 47–55% (Australian mean 51.9%); orthopaedic and neuro-surgeons were more willing than AHPs. Conclusion. Whilst BCC was preferred for all five patient cases, just over half of survey respondents in both the UK and Australia were willing to randomise cases to either LFS or BCC, indicating clinical equipoise (collective uncertainty) needed for RCT recruitment. Conflicts of interest. None. Sources of funding. No specific funding obtained for the surveys. DB, SA, AG and NEF have funding from the National Institute for Health Research (NIHR) UK (FORENSIC-UK NIHR134859); NEF, DB and SA have funding from the Australian National Health and Medical Research Council (NHMRC FORENSIC-Australia GA268233). AG has funding from Orthopaedic Research UK (combined with British Association of Spine Surgeons and British Scoliosis Society) and Innovate UK. NEF is funded through an Australian National Health and Medical Research Council (NHMRC) Investigator Grant (ID: 2018182)

Background:. Following lumbar spine surgery patients with a high BMI appear to have increased post-operative complications including surgical site infections (SSI), urinary complications, increased anaesthetic/operative time and a greater need for post-operative blood transfusion. There is no current evidence, however, analysing the effect of BMI on functional outcome. Purpose:. We aimed to analyse the effect of BMI on functional outcome following lumbar spine surgery. Study Design:. Retrospective Cohort Study. Patient Sample:. 131. Outcome Measures:. Outcome measures included mean post-operative Oswestry Disability Index (ODI) at six and twelve months, the incidence of SSI, mean operative time and the requirement for post-operative blood transfusion. Methods:. Patients that underwent lumbar spinal surgery between September 2010 and November 2013 were identified retrospectively and categorised into discectomy, decompression, fusion and revision is created. A BMI threshold of 30 was used to group patients as non-obese or obese. Univariate analysis was used to compare the effect of BMI on the above outcome measures. Results:. Post-operative complication rates were higher in the obese group in each category. However, there was no significant difference in the post-operative ODI at six ad twelve months post-operatively. Conclusions:. Increased BMI is related to increased post-operative complications but is not associated with a poorer functional outcome in the short to mid-term

Purpose. The behavioural change wheel methodology and social cognitive theory were combined to inform and develop a rehabilitation programme following lumbar fusion surgery (REFS). This qualitative study evaluated participant's experiences of lumbar fusion surgery, including REFS, to identify valued programme content (‘active ingredients’). Background. A feasibility-RCT suggested REFS achieved a meaningful impact in disability and pain self-efficacy compared to ‘usual care’ (p=0.014, p=0.007). In keeping with MRC guidance a qualitative evaluation was undertaken to understand possible mechanisms of action. Methods. Thematic analysis was utilised on data from semi-structured, face-to-face interviews, in a purposive sample (REFS n=10, ‘usual care’ n=10). Results. Three themes (8 sub-themes) were identified, which illuminated the experiences of 1) the impact of living with a chronic lumbar disorder 2) reflections on recovery, and 3) the experience of rehabilitation with(out) REFS. REFS participants identified valued programme content including the opportunity for vicarious learning, the shared rehabilitation experience, and expert physiotherapy. They were unable to identify pre-eminent programme content, in keeping with inter-dependent ‘active ingredients’. Abstraction with the overarching theme of ‘loss of self’ was evident for analysis across all themes. Conclusion. In conclusion the findings were theoretically congruous with other published works e.g. recent mega-ethnographic review of patients experience of chronic non-malignant pain. Two emergent areas were identified to inform future REFS iterations and better understand potential mechanisms of action. 1-Participants fear of harm appears directly attributable to the instillation of metalware, this association is mediated by inadequate advice. 2-Lumbar fusion surgery is not perceived as elective. No conflicts of interest. Funding; NIHR (Doctoral fellowship, awarded to J Greenwood)

Aim. To use Patient Reported Outcome Measures (PROMs) to determine the effectiveness of lumbar spinal surgery at a single UK institution. Methods. Consecutive patients who underwent lumbar spinal surgery (discectomies or decompressions) from 1 January 2011 to 13 March 2013 at a UK District General Hospital were assessed. The procedures were performed or supervised by a senior Consultant Orthopaedic spinal surgeon. All patients completed PROM questionnaires before and three months following surgery. These included Visual Analogue Scores (VAS), SF-12, Oswestry Disability Index (ODI) and Roland Morris Low Back Pain Questionnaire (RMQ). Results. A total of 230 patients had surgery. Of these, 189 (82%) completed both pre- and post-operative questionnaires. All PROMs showed improvement: VAS for constant back pain improved from 4.1 to 2.1 and exacerbations of back pain from 5.8 to 2.4. VAS for constant leg pain improved from 6.3 to 1.7 and for exacerbations of leg pain from 8.2 to 1.8. Mean ODI from 47 to 21; RMQ from13 to 5; and SF12-psychological and physical components increased by 7.2 and 12.4, respectively. Those patients with better psychological health pre-operatively, (high SF-12 score, >60 [n=14]) had a reduction in mean score (decrease of 3.2) post-operatively. However, those with poorer psychological health pre-operatively (low SF-12 score, <30 [n=18]) showed a marked improvement in mean score post-operatively (increase of 18.9). Conclusions. These results show that lumbar spinal surgery is safe and effective at a District General Hospital. Baseline psychological scores may help predict psychological outcomes following surgery. This warrants further prospective evaluation. This abstract has not been previously published in whole or substantial part nor has it been presented previously at a national meeting. Conflicts of interest: No conflicts of interest. Sources of funding: No funding obtained

Male retrograde ejaculation is a well-documented but rare complication of anterior approach lumbar spine surgery. Retraction of the soft tissues which encase the superior hypogastric plexus leads to dysfunction of the sympathetic control of the bladder neck sphincter. We postulated that similar nerve root dysfunction in females may lead to bladder problems and sexual dysfunction. The Female Sexual Function Index Questionnaire was sent to 20 consecutive women who had undergone anterior spinal surgery by the senior author (GM). Questionnaires were returned by 11 of the 20 subjects. 6 had undergone disc replacement surgery and 5 anterior lumbar interbody fusion. All procedures used an anterior retroperitoneal approach. The age range was 20 to 49 years (mean 40.2 years). There were no immediate peri-operative complications. The mean time since surgery was 4.9 years (range 3.1 to 5.8 years). The Female Sexual Function Index is a validated questionnaire used internationally as the gold standard measure of sexual dysfunction in women. Urinary frequency and incontinence were also recorded. 9 women (82%) described a degree of post-operative sexual dysfunction with 7 (64%) recording urinary frequency and urge incontinence. Although some sexual dysfunction may be expected from pre-existing conditions, we highlight this complication following anterior lumbar spine surgery in females. We plan to further investigate its incidence and possible resolution of symptoms after a prolonged period in a larger case series

To establish whether incidental durotomy complicating lumbar spine surgery adversely affects long-term outcome. Data was collected prospectively. The study population comprised 200 patients. 19 patients who sustained dural tears (Group A) were compared to a control group of 181 patients with no tear (Group B). Outcomes were measured with the SF-36, Oswestry Disability Index (ODI) and visual analogue scores for back (VB) and leg (VL) pain. Scores for the 2 groups were compared pre-operatively, at 2 and 6 months post-op for all patients and at long-term follow-up (range 2-9 years) for patients in group A. In addition for patients in group A the patients satisfaction with the procedure, ongoing symptoms, employment status and analgesic intake were documented. Pre-operative scores were similar between the 2 groups apart from significantly higher vb scores (63 –A vs 46-B). Results at 2 and 6 months showed no significant differences between the 2 groups. Outcome scores for group A at long-term follow-up do not show any significant decline. Our study demonstrates that incidental dural tears complicating lumbar spine surgery do not adversely affect outcome in the long-term

Purpose. To establish whether incidental durotomy complicating lumbar spine surgery adversely affects long-term outcome. Methods. Data was collected prospectively. The study population comprised 200 patients. 19 patients who sustained dural tears (Group A) were compared to a control group of 181 patients with no tear (Group B). Outcomes were measured with the SF-36, Oswestry Disability Index (ODI) and visual analogue scores for back (VB) and leg (VL) pain. Scores for the 2 groups were compared pre-operatively, at 2 and 6 months post-op for all patients and at long-term follow-up (range 2-9 years) for patients in group A. In addition for patients in group A the patients satisfaction with the procedure, ongoing symptoms, employment status and analgesic intake were documented. Results. Pre-operative scores were similar between the 2 groups apart from significantly higher vb scores (63 –A vs 46-B). Results at 2 and 6 months showed no significant differences between the 2 groups. Outcome scores for group A at long-term follow-up do not show any significant decline. Conclusion. Our study demonstrates that incidental dural tears complicating lumbar spine surgery do not adversely affect outcome in the long-term. Ethics - none, Interest –none

Lumbar decompression-fusion surgery involves extensive surgery in prone position and is associated with significant post-op ileus. We compared the post-operative oral intake regimes of our two spinal firms over a 6 months period. The post operative oral intake was commenced as soon as the bowel sounds started in one firm. In the other firm, the oral intake was started only after the patient passed wind. There were 28 patients in the first group (bowel sounds) and 27 patients in the second group (passage of wind). The two groups were comparable for age and sex distribution. The average age was 69 yrs, and the male: female ratio was 1.2:1. The bowel sounds were found to start on an average of 8.5 hours (6-16 hours) post-operatively. The average time between the operation and the patient passing wind was 26 hours (18-73 hours). The patients who were on Patient Controlled Analgesia (PCA) were found to have a delayed passage of wind. There was no significant correlation between the number of fusion levels or the operative time and commencement of bowel sounds/ passage of wind. The patient satisfaction rate was much better when the oral intake was commenced as soon as the bowel sounds start. The incidence of nausea/vomiting was significantly less in the group in which the oral intake was commenced following patient passing wind. The bloating of the abdomen was found in the first group. Audit Committee Interest statement: No conflict of interest

Introduction. Both intra- and post-operative radiographs are traditionally obtained after instrumented lumbar spinal surgery; however the clinical advantage of routine post operative images has not been demonstrated. Aim. To explore the usefulness of routine pre-discharge postoperative radiographs in patients undergoing instrumented spinal surgery. Methodology. Patients (n = 124) who underwent a lumbar spinal fusion were identified from a retrospective database, 58 patients were excluded. Unaltered intra-operative and pre-discharge post-operative PACS images for 66 patients were reviewed and were scored for: i) Quality (0 = non-diagnostic, 1 = suboptimal, 2 = diagnostic, 3 = good quality), ii) Focus (number of vertebra and disc seen), iii) Centering using a numbered (1–9) grid system, and iv) Rotation. Results. 66 radiographs were analysed for i) Quality: 60 AP and 56 lateral intra-operative images while 57 AP and 39 lateral postoperative images were diagnostic, ii) Focus: average number of unnecessary vertebra seen in intra-operative AP and lateral images were 0.89 and 1.09, while on post-operative AP and lateral images were 8.05 and 6.45 respectively, iii) Centering: 48 AP and 51 lateral intra-operative images, while 27 AP and 20 lateral post-operative images were adequately centered and iv) Rotation was adequate in both intra-operative and post-operative images. Conclusion. Intra-operative images scored higher in all parameters suggesting that routine post-operative pre-hospital discharge radiographs are unnecessary unless specifically indicated and this practice should be discontinued with benefits including reduction of radiation dose (and subsequent sequelae), fiscal burden and length of stay

Aim. To assess the safety of day case lumbar decompressive surgery. Method. Retrospective study of 233 consecutive patients undergoing DCLDS who were identified from a prospective electronic database. Results. Between Jan 2011 and April 2014, 131 open and 102 microscopic surgeries were done in patients with mean age of 46 (16–88) years and male: female ratio of 136 (59%):97 (41%). Inclusion criteria were no known anesthetic reaction, ASA grade I or II, BMI <35, less than 30 minutes travel time and responsible home carer. Patients were discharged after clinical assessment with cauda equina advice and emergency contact number. 215 (92%) procedures were single level, of which 188(87%) unilateral and 27 (13%) were bilateral procedures. 18 (8%) procedures were multiple levels, of which 12(67%) unilateral and 6 (33%) were bilateral procedures. Majority, 107 (50%), 97 (45%) procedures were done at L5/S1 and L4/L5 levels respectively and rest 11(5%) at higher level. The 7 day and 30 day re-presentation figures were 7 (3%) & 15(6.4%) as following: Pain (n=3), Medication (n=2), Wound issues (n=5), Infection (n=2), Headache (n=2), ?VTE (n=1). Eleven were sent home and 4 (1.7%) were admitted with 2 requiring further surgery, one revision discectomy and one wound washout. No cauda equina or compressive haematoma were encountered. Conclusion. This study demonstrates that open and microscopic lumbar discectomy at single or multiple levels can be performed safely as a day case procedure. The representation rate to the ED can be potentially reduced by better advice and pain management. Conflicts of interest: No conflicts of interest. Sources of funding: No funding obtained

Healthcare interventions are under increasing scrutiny regarding cost-effectiveness and outcome measures have revolutionised clinical research.

To identify all available outcome questionnaires designed for lowback, lumbar spine pathologies and to perform qualitative analysis of these questionnaires for their clinimetric properties.

A comprehensive e-search on PUBMED & EMBASE for all available outcome measures and published review articles for lowback and lumbar spine pathologies was undertaken over a two month period (Nov-Dec 2009). Twenty-eight questionnaires were identified in total. These outcomes questionnaires were evaluated for clinimetric properties viz:-

Validity (content, construct & criterion validity)

Reliability (internal consistency & reproducibility)

Responsiveness and scored on a scale of 0-6 points.

Eight outcomes questionnaires had satisfied all clinimetric domains in methodological evaluation (score 6/6).

Oswestry disability index (ODI)

Roland-Morris disability questionnaire (RMDQ)

Aberdeen lowback pain scale

Extended Aberdeen spine pain scale

Functional rating index

Core lowback pain outcome measure

Backpain functional scale

Maine-Seattle back questionnaire.

Sixteen of these questionnaires scored =5 when evaluated for clinimetric domains. RMDQ had the highest number of published and validated translations followed by ODI. Criterion validity was not tested for NASS-AAOS lumbar spine questionnaire.

32%(9/28) of the outcome instruments have undergone methodological evaluation for =3 clinimetric properties. Clinicians should be cautious when choosing appropriate validated outcome measures when evaluating therapeutic/surgical intervention. We suggest use of few validated outcome measures with high clinimetric scores (=5/6) to be made mandatory when reporting clinical results.

Aims. Repeated lumbar spine surgery has been associated with inferior clinical outcomes. This study aimed to examine and quantify the impact of this association in a national clinical register cohort. Methods. This is a population-based study from the Norwegian Registry for Spine surgery (NORspine). We included 26,723 consecutive cases operated for lumbar spinal stenosis or lumbar disc herniation from January 2007 to December 2018. The primary outcome was the Oswestry Disability Index (ODI), presented as the proportions reaching a patient-acceptable symptom state (PASS; defined as an ODI raw score ≤ 22) and ODI raw and change scores at 12-month follow-up. Secondary outcomes were the Global Perceived Effect scale, the numerical rating scale for pain, the EuroQoL five-dimensions health questionnaire, occurrence of perioperative complications and wound infections, and working capability. Binary logistic regression analysis was conducted to examine how the number of previous operations influenced the odds of not reaching a PASS. Results. The proportion reaching a PASS decreased from 66.0% (95% confidence interval (CI) 65.4 to 66.7) in cases with no previous operation to 22.0% (95% CI 15.2 to 30.3) in cases with four or more previous operations (p < 0.001). The odds of not reaching a PASS were 2.1 (95% CI 1.9 to 2.2) in cases with one previous operation, 2.6 (95% CI 2.3 to 3.0) in cases with two, 4.4 (95% CI 3.4 to 5.5) in cases with three, and 6.9 (95% CI 4.5 to 10.5) in cases with four or more previous operations. The ODI raw and change scores and the secondary outcomes showed similar trends. Conclusion. We found a dose-response relationship between increasing number of previous operations and inferior outcomes among patients operated for degenerative conditions in the lumbar spine. This information should be considered in the shared decision-making process prior to elective spine surgery. Cite this article: Bone Joint J 2023;105-B(4):422–430

Aims. Chronic low back pain due to degenerative disc disease is sometimes treated with fusion. We compared the outcome of three different fusion techniques in the Swedish Spine Register: noninstrumented posterolateral fusion (PLF), instrumented posterolateral fusion (IPLF), and interbody fusion (IBF). Patients and Methods. A total of 2874 patients who were operated on at one or two lumbar levels were followed for a mean of 9.2 years (3.6 to 19.1) for any additional lumbar spine surgery. Patient-reported outcome data were available preoperatively (n = 2874) and at one year (n = 2274), two years (n = 1958), and a mean of 6.9 years (n = 1518) postoperatively and consisted of global assessment and visual analogue scales of leg and back pain, Oswestry Disability Index, EuroQol five-dimensional index, 36-Item Short-Form Health Survey, and satisfaction with treatment. Statistical analyses were performed with competing-risks proportional hazards regression or analysis of covariance, adjusted for baseline variables. Results. The number of patients with additional surgery were 32/183 (17%) in the PLF group, 229/1256 (18%) in the IPLF group, and 439/1435 (31%) in the IBF group. With the PLF group as a reference, the hazard ratio for additional lumbar surgery was 1.16 (95% confidence interval (CI) 0.78 to 1.72) for the IPLF group and 2.13 (95% CI 1.45 to 3.12) for the IBF group. All patient-reported outcomes improved after surgery (p < 0.001) but were without statistically significant differences between the groups at the one-, two- and 6.9-year follow-ups (all p ≥ 0.12). Conclusion. The addition of interbody fusion to posterolateral fusion was associated with a higher risk for additional surgery and showed no advantages in patient-reported outcome. Cite this article: Bone Joint J 2019;101-B:1526–1533

Aims. The purpose of this study was to investigate the risk of additional surgery in the lumbar spine and to describe long-term changes in patient-reported outcomes after surgery for lumbar disc herniation in adolescents and young adults. Patients and Methods. We conducted a retrospective study design on prospectively collected data from a national quality register. The 4537 patients were divided into two groups: adolescents (≤ 18 years old, n = 151) and young adults (19 to 39 years old, n = 4386). The risk of additional lumbar spine surgery was surveyed for a mean of 11.4 years (6.0 to 19.3) in all 4537 patients. Long-term patient-reported outcomes were available at a mean of 7.2 years (5.0 to 10.0) in up to 2716 patients and included satisfaction, global assessment for leg and back pain, Oswestry Disability Index, visual analogue scale for leg and back pain, EuroQol five-dimension questionnaire (EQ-5D), and 36-Item Short-Form Health Survey (SF-36) Mental Component Summary and Physical Component Summary scores. Statistical analyses were performed with Cox proportional hazard regression, chi-squared test, McNemar’s test, Welch–Satterthwaite t-test, and Wilcoxon’s signed-rank test. Results. Any type of additional lumbar spine surgery was seen in 796 patients (18%). Surgery for lumbar disc herniation accounted for more than half of the additional surgeries. The risk of any additional surgery was 0.9 (95% confidence interval (CI) 0.6 to 1.4) and the risk of additional lumbar disc herniation surgery was 1.0 (0.6 to 1.7) in adolescents compared with the young adult group. Both age groups improved their patient-reported outcome data after surgery (all p < 0.001). Changes between short- (mean 1.9 years (1.0 to 2.0)) and long-term follow-up (mean 7.2 years (5.0 to 10.0)) were small. Conclusion. The risk of any additional lumbar spine surgery and additional lumbar disc herniation surgery was similar in adolescents and young adults. All patient-reported outcomes improved from preoperative to the short-term follow-up, while no likely clinically important differences between the short- and long-term follow-up were seen within both groups. Cite this article: Bone Joint J 2019;101-B:1534–1541