TLIF is Associated With Lower Rates of Adjacent Segment Disease and Complications Compared to ALIF-Reference-Cited by-同舟云学术

TLIF is Associated With Lower Rates of Adjacent Segment Disease and Complications Compared to ALIF

Published:2023-05-04 Issue:19 Volume:48 Page:1335-1341
ISSN:0362-2436
Container-title:Spine
language:en
Short-container-title:

Author:

Tao Xu¹^ORCID,Matur Abhijith V.¹,Khalid Syed²,Onyewadume Louisa³⁴,Garner Rebecca¹,McGrath Kyle¹,Owen Bryce¹,Gibson Justin¹,Cass Daryn¹,Mejia Munne Juan C.¹,Vorster Phillip¹,Shukla Geet¹,Gupta Sahil¹,Wu Andrew¹,Childress Kelly¹,Palmisciano Paolo¹,Duah Henry O.⁵,Motley Benjamin¹,Cheng Joseph¹,Adogwa Owoicho¹

Affiliation:

1. Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH

2. Department of Neurosurgery, University of Illinois College of Medicine, Chicago, IL

3. Department of Global Health and Population, Harvard University T.H. Chan School of Public Health, Boston, MA

4. Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA

5. Institute for Nursing Research & Scholarship, University of Cincinnati College of Nursing, Cincinnati, OH

Abstract

Study Design.Retrospective cohort.Objective.To compare the rate of adjacent segment disease (ASD) in patients undergoing anterior lumbar interbody fusion (ALIF) versus transforaminal lumbar interbody fusion (TLIF) for the treatment of degenerative stenosis and spondylolisthesis.Summary of Background Data.ALIF and 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 ASD and postoperative complications.Methods.A retrospective cohort study of patients who underwent index 1-3 levels ALIF or TLIF between 2010 and 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. Exact 1:1 matching was performed 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 all-cause medical and surgical complications.Results.Exact 1:1 matching resulted in 2 equal groups of 106,451 patients undergoing TLIF and ALIF. The TLIF approach was associated with a lower risk of ASD (RR 0.58, 95% CI 0.56–0.59,P< 0.001) and all-cause medical complications (RR 0.94, 95% CI 0.91–0.98,P=0.002). All-cause surgical complications were not significantly different between both groups.Conclusion.After 1:1 exact matching to control for confounding variables, this study suggests that for patients with symptomatic degenerative stenosis and spondylolisthesis, a TLIF procedure (compared to ALIF) is associated with a decreased risk of developing ASD within 36 months of index surgery. Future prospective studies are needed to corroborate these findings.Level of Evidence.Level—3

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Neurology (clinical),Orthopedics and Sports Medicine

Reference29 articles.

1. Clinical implications of lumbar developmental spinal stenosis on back pain, radicular leg pain, and disability;Lai;Bone Joint J,2021

2. Association of Lumbar Spinal Stenosis With Severe Disability and Mortality Among Community-Dwelling Older Adults;Hijikata;Spine (Phila Pa 1976),2021

3. Walking assessment in people with lumbar spinal stenosis: capacity, performance, and self-report measures;Conway;Spine J,2011

4. Disability and Walking Capacity in Patients With Lumbar Spinal Stenosis: Association With Sensorimotor Function, Balance, and Functional Performance;Lin;J Orthop Sports Phy Ther,2005

5. The minimally invasive interbody selection algorithm for spinal deformity;Mummaneni;J Neurosurg Spine,2021