Risk Factors and Reoperation Rate in Revision Lumbar Disc Herniation Surgery: A Systematic Review and Meta-Analysis of 1,031,348 Patients

Abstract

Study Design A systematic review and meta-analysis. Objectives To estimate reoperation rate after lumbar disc herniation surgery and identify associated risk factors. Methods We searched PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Scopus, and Embase to April 2025 for English-language randomized controlled trials and observational studies reporting risk factors and reoperation rates. Two reviewers independently screened studies, extracted data, and assessed quality using the Newcastle–Ottawa Scale and Cochrane Risk of Bias 2.0 tool. Meta-analysis used fixed-effect model. Results Twenty-five studies (1,031,348 patients) met the inclusion criteria. The pooled reoperation rate was 8.5% (95% CI: 6.2%-11.6%), rising with follow-up: 4% at ≤1 year, 11.1% at 1-5 years, and 8.8% beyond 5 years ( P < 0.0001 for subgroup differences). Smoking (OR 1.39; 95% CI: 1.09-1.78), older age (OR 1.52; 95% CI: 1.25-1.85), and large annular defect size (OR 2.19; 95% CI: 1.07-4.48) were significant risk factors; sex was not (OR 1.22; 95% CI: 0.96-1.55). Diabetes and certain surgical techniques were also linked to higher risk in individual studies. Adjustment for publication bias increased the overall pooled rate to 10.3% (95% CI: 7.6%-14.0%). Conclusions Reoperation rates after lumbar disc herniation surgery differ by follow-up duration: 4% at ≤1 year, 11.1% at 1-5 years, and 8.8% beyond 5 years. Smoking, older age, diabetes, and large annular defects were significant risk factors. Recognizing high-risk patients can support decisions for extended conservative care or closer follow-up. Further studies should compare revision techniques to improve long-term outcomes.