Reasons for revision following stand-alone anterior lumbar interbody fusion and lateral lumbar interbody fusion

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  • 1 Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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OBJECTIVE

Anterior lumbar interbody fusion (ALIF) and lateral lumbar interbody fusion (LLIF) are alternative and less invasive techniques to stabilize the spine and indirectly decompress the neural elements compared with open posterior approaches. While reoperation rates have been described for open posterior lumbar surgery, there are sparse data on reoperation rates following these less invasive procedures without direct posterior decompression. This study aimed to evaluate the overall rate, cause, and timing of reoperation procedures following anterior or lateral lumbar interbody fusions without direct posterior decompression.

METHODS

This was a retrospective cohort study of all consecutive patients indicated for an ALIF or LLIF for lumbar spine at a single academic institution. Patients who underwent concomitant posterior fusion or direct decompression surgeries were excluded. Rates, causes, and timing of reoperations were analyzed. Patients who underwent a revision decompression were matched with patients who did not require a reoperation, and preoperative imaging characteristics were analyzed to assess for risk factors for the reoperation.

RESULTS

The study cohort consisted of 529 patients with an average follow-up of 2.37 years; 40.3% (213/529) and 67.3% (356/529) of patients had a minimum of 2 years and 1 year of follow-up, respectively. The total revision rate was 5.7% (30/529), with same-level revision in 3.8% (20/529) and adjacent-level revision in 1.9% (10/529) of patients. Same-level revision patients had significantly shorter time to revision (7.14 months) than adjacent-level revision patients (31.91 months) (p < 0.0001). Fifty percent of same-level revisions were for a posterior decompression. After further analysis of decompression revisions, an increased preoperative canal area was significantly associated with a lower risk of further decompression revision compared to the control group (p = 0.015; OR 0.977, 95% CI 0.959–0.995).

CONCLUSIONS

There was a low reoperation rate after anterior or lateral lumbar interbody fusions without direct posterior decompression. The majority of same-level reoperations were due to a need for further decompression. Smaller preoperative canal diameters were associated with the need for revision decompression.

ABBREVIATIONS

ALIF = anterior lumbar interbody fusion; ASD = adjacent-segment disease; LLIF = lateral lumbar interbody fusion; ODI = Oswestry Disability Index; VAS = visual analog scale.
Illustrations from Walker et al. (pp 80–90). © Barrow Neurological Institute, Phoenix, Arizona.

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Contributor Notes

Correspondence Krishn Khanna: Rush University Medical Center, Chicago, IL. krishnkhanna@gmail.com.

INCLUDE WHEN CITING Published online April 30, 2021; DOI: 10.3171/2020.10.SPINE201239.

Disclosures Dr. Phillips: direct stock ownership in Augmentics, NuVasive, Spinal Simplicity, Surgio, Thereacell, Edge Surgical, and SI Bone; consultant for NuVasive, Stryker, SI Bone, Globus, and Orthofix; and royalties from NuVasive and Medtronic. Dr. Singh: direct stock ownership in Avaz Surgical LLC and Vital 5 LLC; royalties from Zimmer Biomet, RTI Surgical, Lippincott Williams & Wilkins, Thieme, Jaypee Publishing, and Slack Publishing; consultant for Zimmer Biomet and K2M; board member of Vital 5 LLC and Minimally Invasive Spinal Group. Dr. Colman: consultant for K2M, Orthofix, Alphatec, Spinal Elements, and HT Medical.

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