Low-Density Lipoprotein Cholesterol and Statin Usage Are Associated With Rates of Pseudarthrosis Following Single-Level Posterior Lumbar Interbody Fusion

Abstract

Study design. Retrospective cohort study Objective. To investigate the relationships of low-density lipoprotein (LDL) cholesterol and statin usage with pseudarthrosis following single-level posterior or transforaminal lumbar interbody fusion (PLIF/TLIF). Summary of background data. Hypercholesterolemia can lead to atherosclerosis of the segmental arteries which branch into vertebral bone through intervertebral foramina. According to the vascular hypothesis of disc disease, this can lead to ischemia of lumbar discs and contribute to lumbar degenerative disease. Yet, little has been reported regarding the effects of cholesterol and statins on the outcomes of lumbar fusion surgery. Methods. TriNetX, a global federated research network, was retrospectively queried to identify 52,140 PLIF/TLIF patients between 2002 and 2021. Of these patients, 2,137 had high cholesterol (≥ 130 mg/dL) and 906 (≤ 55 mg/dL) had low cholesterol. Perioperatively, 18,275 patients used statins, while 33,415 patients did not. One-to-one propensity score matching for age, sex, race, and comorbidities was conducted to balance the analyzed cohorts. The incidence of pseudarthrosis was then assessed in the matched cohorts within the 6-month, 1-year, and 2-year postoperative periods. Results. After propensity score matching, high cholesterol patients had greater odds of developing pseudarthrosis 6 months (OR: 1.73, 95% CI: 1.28-2.33), 1 year (OR: 1.59, 95% CI: 1.20-2.10), and 2 years (OR: 1.57, 95% CI: 1.20-2.05) following a PLIF/TLIF procedure. Patients with statin usage had significantly lower odds of developing pseudarthrosis 6 months (OR: 0.74, 95% CI: 0.69-0.79), 1 year (OR: 0.76, 95% CI: 0.71-0.81), and 2 years (OR: 0.77, 95% CI: 0.72-0.81) following single-level PLIF/TLIF. Conclusions. Our findings suggest that patients with hypercholesterolemia is associated with an increased risk of developing pseudarthrosis following PLIF/TLIF while statin use is associated with a decreased risk. The data presented may underscore an overlooked opportunity for perioperative optimization in lumbar fusion patients, warranting further investigation in this area.