University of Oulu

Anna Kotkansalo, MD, Ville Leinonen, MD, PhD, Prof, Merja Korajoki, MSc, Katariina Korhonen, MD, PhD, Jaakko Rinne, MD, PhD, Prof, Antti Malmivaara, MD, PhD, Prof, Occurrence, Risk Factors, and Time Trends for Late Reoperations due to Degenerative Cervical Spine Disease: A Finnish National Register Study of 19 377 Patients Operated on Between 1999 and 2015, Neurosurgery, Volume 88, Issue 3, March 2021, Pages 558–573,

Occurrence, risk factors, and time trends for late reoperations due to degenerative cervical spine disease : a Finnish national register study of 19 377 patients operated on between 1999 and 2015

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Author: Kotkansalo, Anna1,2,3; Leinonen, Ville4,5,6,7; Korajoki, Merja3;
Organizations: 1Turku University Hospital, Division of Clinical Neurosciences, Department of Neurosurgery, Turku, Finland
2University of Turku, Faculty of Medicine, Department of Clinical Medicine, Turku, Finland
3National Institute for Health and Welfare, Centre for Health and Social economics, Helsinki, Finland
4Unit of Clinical Neuroscience, Neurosurgery, University of Oulu, Oulu, Finland
5Medical Research Center, Oulu University Hospital, Oulu, Finland
6Institute of Clinical Medicine – Neurosurgery, University of Eastern Finland, Kuopio, Finland
7Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
8Welfare District of Forssa, Forssa, Finland
9Orton Orthopedic Hospital, Helsinki, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.7 MB)
Persistent link:
Language: English
Published: Oxford University Press, 2021
Publish Date: 2021-05-12


Background: Surgery for degenerative cervical spine disease has escalated since the 1990s. Fusion has become the mainstay of surgery despite concerns regarding adjacent segment degeneration. The patient-specific trends in reoperations have not been studied previously.

Objective: To analyze the occurrence, risk factors, and trends in reoperations in a long-term follow-up of all the patients operated for degenerative cervical spine disease in Finland between 1999 and 2015.

Methods: The patients were retrospectively identified from the Hospital Discharge Registry. Reoperations were traced individually; only reoperations occurring >365 d after the primary operation were included. Time trends in reoperations and the risk factors were analyzed by regression analysis.

Results: Of the 19 377 identified patients, 9.2% underwent a late reoperation at a median of 3.6 yr after the primary operation. The annual risk of reoperation was 2.4% at 2 yr, 6.6% at 5 yr, 11.1% at 10 yr, and 14.2% at 15 yr. Seventy-five percent of the late reoperations occurred within 6.5 yr of the primary operation. Foraminal stenosis, the anterior cervical decompression and fusion (ACDF) technique, male gender, weak opiate use, and young age were the most important risk factors for reoperation. There was no increase in the risk of reoperations over the follow-up period.

Conclusion: The risk of reoperation was stable between 1999 and 2015. The reoperation risk was highest during the first 6 postoperative years and then declined. Patients with foraminal stenosis had the highest risk of reoperation, especially when ACDF was performed.

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Series: Neurosurgery
ISSN: 0148-396X
ISSN-E: 1524-4040
ISSN-L: 0148-396X
Volume: 88
Issue: 3
Pages: 558 - 573
DOI: 10.1093/neuros/nyaa464
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
3112 Neurosciences
Funding: The Hospital district of Helsinki and Uusimaa has granted the study group and the responsible investigator Prof. Antti Malmivaara State research funding through the Orton Research Foundation (grant number 9310/403).
Copyright information: © Congress of Neurological Surgeons 2020. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (, which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact