Resident Physician University of Illinois at Chicago Chicago, Illinois, United States
Disclosure(s):
Syed I. Khalid, MD: No financial relationships to disclose
Introduction: Lumbar disc arthroplasty (LDA) and anterior lumbar interbody fusion (ALIF) are alternative surgical approaches used to treat lumbar degenerative disc disease. However, comparing the risk of adjacent segment disease (ASD) and complications between the two procedures has been difficult because LDA is typically performed in younger and often healthier patients. The objective of this study is to compare the rate of ASD between LDA and ALIF.
Methods: Patients who underwent 1-2 level LDA or ALIF between 2010 and 2022 were identified in the PearlDiver Mariner insurance all-claims database, an all-claims insurance database (120 million patients). Patients with a history of prior lumbar procedures and those undergoing surgery for tumors, trauma, or infection were excluded. 1:1 propensity matching was performed using demographic factors, medical comorbidities, and surgical factors which were significantly associated with ASD in a linear regression model. The primary outcome measure was development of ASD within 12 months of index surgery. Secondary outcomes were all-cause medical and surgical complications.
Results: 1:1 Propensity matching created two equal groups of 1625 patients without baseline differences who underwent LDA and ALIF. LDA was significantly associated with lower risk of ASD (RR 0.932, 95% CI 0.899-0.967, p< 0.001), and need for revision within 30 days (RR 0.235, 95% CI 0.079-0.698, p = 0.007). There were no differences in all-cause surgical and medical complications between both groups.
Conclusion : After risk adjustment for patient demographics (including age) and comorbidities, the results of this study suggest that LDA is associated with a lower risk of ASD compared to ALIF.
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