Lumbar Arthroplasty is Associated with a Lower Incidence of Adjacent Segment Disease Compared to ALIF

Abstract

Study Design. Retrospective Cohort Study Objective. The objective of this study was to compare the rate of adjacent segment disease (ASD) between lumbar disk arthroplasty (LDA) and anterior lumbar interbody fusion (ALIF). Summary of Background Data. LDA and ALIF are alternative surgical approaches used to treat lumbar degenerative disk disease. However, there is a paucity of studies comparing the risk of ASD after these procedures. Methods. Patients who underwent 1- to 2-level LDA or ALIF between 2010 and 2022 were identified in the PearlDiver Mariner insurance all-claims database. Exclusion criteria included the history of prior lumbar spine surgery or surgery for tumors, trauma, or infection. 1:1 propensity matching was performed using demographic factors, medical comorbidities, and surgical factors, which were significantly associated with ASD. Results. 1:1 propensity matching created two equal groups of 1625 patients without baseline differences who underwent LDA or ALIF. LDA was significantly associated with a lower risk of ASD (relative risk: 0.932, 95% CI, 0.899–0.967, P<0.001) and need for revision within 30 days (relative risk: 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. Conclusions. After risk adjustment for demographic and clinical characteristics, the results suggest that LDA is associated with a lower risk of ASD compared with ALIF. LDA was also associated with lower hospital cost and shorter length of stay.

ALIF and TLIF Likely Have Similar Reoperation Rates – A Response To “TLIF is Associated With Lower Rates of Adjacent Segment Disease and Complications Compared to ALIF”

“…The ICD/CPT codes used to query for ASD were not provided. Specific ICD codes do not exist at each lumbar level (unlike cervical disease), prohibiting querying for adjacent levels. The reported rates may be all-cause subsequent surgeries rather than solely surgeries for ASD secondary to index surgery. The study shows a ~7.5% difference in ASD rate, suggesting ALIF is significantly worse. This may stem from staged ALIF procedures, with the posterior approach occurring several days after the anterior approach. This would overestimate the incidence of ASD as queried with CPT codes. A Kaplan-Meier curve would illustrate if this were happening, like the one shown in the paper by Shukla et al 2 this study from the same group shows that in a similar but significantly smaller pearldiver cohort, ~7.5% of the reoperations in an alif cohort occurred in the first few days after surgery, which would likely be accounted for by planned staged surgeries. ASD does not occur within days. …”

“…A Kaplan-Meier curve would illustrate if this were happening, like the one shown in the paper by Shukla et al 2 this study from the same group shows that in a similar but significantly smaller pearldiver cohort, ~7.5% of the reoperations in an alif cohort occurred in the first few days after surgery, which would likely be accounted for by planned staged surgeries.…”

Development of gelatin-methacryloyl composite carriers for bone morphogenetic Protein-2 delivery: A potential strategy for spinal fusion

“…However, surgery involves not only secondary trauma but also many complications, such as fusion failure. [2][3][4] Although various new intervertebral fusion devices and bioactive bone substitute materials have been developed, their therapeutic effects are limited, and there is an urgent need to change the traditional surgical approach.…”