Medical Student UCCOM Cincinnati, Ohio, United States
Disclosure(s):
Xu Tao, MFA: No financial relationships to disclose
Introduction: Anterior lumbar interbody fusions (ALIF) and transforaminal lumbar interbody fusions (TLIF) are frequently used to treat Lumbar stenosis and spondylolisthesis. While both approaches have distinct advantages, it is unclear whether there are any differences in rates of adjacent segment disease (ASD) and postoperative complications. The objective of this study is to compare the rate of ASD between ALIF and TLIF
Methods: This is a retrospective cohort study of patients who underwent index 1-3 levels ALIF or TLIF between 2010-2022, using the PearlDiver Mariner Database, an all-claims insurance database (120 million patients). Patients with a history of prior lumbar surgery and those undergoing surgery for cancer, trauma, or infection were excluded. Propensity matching was performed on a 1:1 basis using demographic factors, medical comorbidities, and surgical factors found to be significantly associated with ASD in a linear regression model. The primary outcome was a new diagnosis of ASD within 36 months of index surgery and secondary outcomes were medical and surgical complications (Pneumonia, overall medical complications).
Results: Propensity matching resulted in two equal groups of 106,451 patients undergoing TLIF and ALIF. A TLIF approach was associated with a lower risk of ASD (RR 0.58, 95% CI 0.56-0.59, P < 0.001), pulmonary embolism (RR 0.80, 95% CI 0.69-0.92, P = 0.002), and overall medical complications (RR 0.94, 95% CI 0.91-0.98, P = 0.002). However, a TLIF approach was associated with increased risk of developing postoperative CSF leak (RR 1.82, 95% CI 1.32-2.52, P < 0.001). Overall surgical complications were not significantly different between both groups.
Conclusion : After propensity matching to control for confounding variables, this study found that TLIF is associated with decreased risk of developing ASD at 36 months postoperatively as well as all-cause medical complications.
