Fusion Technique Does Not Affect Short-Term Patient Reported Outcomes for Lumbar Degenerative Disease.
Authors of this article are:
Divi SN, Schroeder GD, Goyal DK, Radcliff KE, Galetta MS, Hilibrand AS, Anderson DG, Kurd MF, Rihn JA, Kaye ID, Woods BR, Vaccaro AR, Kepler CK.
A summary of the article is shown below:
BACKGROUND/CONTEXT: Degenerative lumbar disease can be addressed via an anterior or posterior approach, and with or without the use of an interbody cage. While several studies have compared the type of approach and technique, there is a lack of literature assessing patient reported outcome measures (PROMs) and radiographic parameters between different fusion techniques.PURPOSE: To determine whether the surgical approach and fusion technique for lumbar degenerative disease had an effect on short-term PROMs and radiographic parameters.STUDY DESIGN/SETTING: Retrospective Cohort Study PATIENT SAMPLE: Three hundred and ninety-one patients that underwent a 1-3 level lumbar spine fusion procedure at a high-volume academic center were retrospectively identified. Patients were divided into three groups based on the type of fusion they underwent: posterolateral fusion (PLF), anterior lumbar interbody fusion (ALIF), or transforaminal lumbar interbody fusion (TLIF).OUTCOME MEASURES: PROMs: Short Form-12 (SF-12) Physical Component Score (PCS) and Mental Component Score (MCS), Oswestry Disability Index (ODI), Visual Analog Score (VAS) Back, VAS Leg. Spinopelvic measurements: Pelvic Tilt (PT), Sacral Slope (SS), Pelvic Incidence (PI), Lumbar Lordosis (LL), Segmental Lordosis (SL), PI-LL mismatch.METHODS: Patients with less than one-year follow-up were excluded from the cohort. Pre- and postoperative spinopelvic measurements were obtained for all patients. Univariate analysis (Chi-squared/Fisher’s exact test or ANOVA test with post-hoc Bonferroni test) was used to compare among the three groups in the PROMs and radiographic spinopelvic parameters. Multiple linear regression was used to determine if fusion technique was an independent predictor of change in each patient outcome.RESULTS: Two hundred and sixteen patients were included in the PLF group, 33 patients in the ALIF group, and 142 patients in the TLIF group. The PLF group was significantly older at baseline (p < 0.001) and had lower preoperative diagnosis rates of degenerative scoliosis and disc herniations (p < 0.001), whereas the ALIF group underwent a higher proportion of 3 level fusions (p < 0.001). There was no significant difference in spinopelvic parameters preoperatively, however the ALIF group showed significantly more improvement in SL postoperatively (p = 0.004) than the PLF and TLIF groups. Within each group, SL improved for the PLF and ALIF groups (p = 0.002 for both), but not for the TLIF group (p = 0.238). Comparing patient outcomes, the ALIF group reported lower preoperative VAS Leg scores (p = 0.031), however this difference resolved postoperatively. Stratifying for preoperative diagnosis, there were no significant differences in outcomes, except for a greater improvement in VAS Leg scores for degenerative scoliosis patients undergoing ALIF. Using multivariate analysis, fusion technique was not found to be a significant predictor of change in any patient outcome or in odds of revision.CONCLUSIONS: Lumbar degenerative disease can be treated with several different fusion techniques, however the relationship between type of fusion and PROMs is not established. Based on the findings in this study, the ALIF group showed greater improvement in SL compared to the PLF and TLIF groups, however there was no difference noted in overall LL, PI-LL mismatch or other spinopelvic parameters. Despite these radiographic findings, patient outcome measures remained similar between all three fusion types.Copyright © 2019. Published by Elsevier Inc.
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This article is a good source of information and a good way to become familiar with topics such as: ALIF;Lumbar fusion;PLF;PROM;TLIF;anterior lumbar interbody fusion;lumbar approach;patient reported outcome measures;posterolateral fusion;spinopelvic parameters;transforaminal lumbar interbody fusion.
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