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• W4248677588 abstract "BACKGROUND CONTEXT Although fusion rates between posterolateral fusions with pedicle screws (PLFs) and anterior lumbar interbody fusions with pedicle screws (ALIFs+PS) have been well studied, there has been no consensus on the better technique with respect to clinical outcome and nonunion rates. Most studies determine nonunion rates based on radiographic studies; however, many of these nonunions are asymptomatic. A more clinically useful measure is the operative nonunion rate. To date, data comparing operative nonunion rates in PLF and ALIF+PS are limited. PURPOSE To determine whether there is a difference between nonunion reoperation rates in PLFs vs anterior lumbar interbody fusions with pedicle screws (ALIFs+PS). STUDY DESIGN/SETTING Retrospective cohort. PATIENT SAMPLE The cohort comprised 8,340 patients aged ≥50 who underwent primary elective lumbar spinal fusion (L1-S1) for degenerative or deformity related spinal disorders (2009-2018). OUTCOME MEASURES Operative nonunions. METHODS Adult patients (≥18 years old) with degenerative disc disease who underwent primary elective PLFs and ALIFs+PS for 1-level and 2-level fusions (L4-S1) between 2009-2018 were identified using data from the Kaiser Permanente Spine Registry and followed until validated operative nonunion, membership termination, death, or 03/31/2019. Descriptive statistics and two-year incidence rates for validated operative nonunions were calculated by fusion level, fusion type, and levels fused. Time-dependent multivariable Cox-Proportional Hazards regression was used to evaluate operative nonunion rates with adjustment for covariates or risk change estimates more than 10%. RESULTS We identified 2,061 patients (PLF:1491, ALIF+PS:570) with average follow-up time of 4.8(±3.1) years, and average time to operative nonunion 1.3(±1.2) yrs. Comparatively, single and multilevel incidence rates for nonunion were higher in PLF vs ALIF+PS: 1-Level: 0.9% (95% CI=0.4-1.6) vs 0.6% (95% CI=0.1-2.1); 2-Level: 2.0% (95% CI=0.8-4.0) vs 0.9% (95% CI=0.1-3.3). There were no observed differences in risk of operative nonunions in multivariable models comparing ALIF+PS vs PLF (HR=0.3, 95% CI=0.1-1.1), 1-level vs 2-level fusions (HR=1.8, 95% CI=0.8-4.3), or by fusion level (L4-L5: HR=1.0, 95% CI=0.4-2.7; L5-S1: HR=2.0, 95% CI=0.7-5.4). CONCLUSIONS A large cohort of patients with >4 years follow-up found no difference in operative nonunions between PLF and ALIF+PS. Further research is warranted. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. Although fusion rates between posterolateral fusions with pedicle screws (PLFs) and anterior lumbar interbody fusions with pedicle screws (ALIFs+PS) have been well studied, there has been no consensus on the better technique with respect to clinical outcome and nonunion rates. Most studies determine nonunion rates based on radiographic studies; however, many of these nonunions are asymptomatic. A more clinically useful measure is the operative nonunion rate. To date, data comparing operative nonunion rates in PLF and ALIF+PS are limited. To determine whether there is a difference between nonunion reoperation rates in PLFs vs anterior lumbar interbody fusions with pedicle screws (ALIFs+PS). Retrospective cohort. The cohort comprised 8,340 patients aged ≥50 who underwent primary elective lumbar spinal fusion (L1-S1) for degenerative or deformity related spinal disorders (2009-2018). Operative nonunions. Adult patients (≥18 years old) with degenerative disc disease who underwent primary elective PLFs and ALIFs+PS for 1-level and 2-level fusions (L4-S1) between 2009-2018 were identified using data from the Kaiser Permanente Spine Registry and followed until validated operative nonunion, membership termination, death, or 03/31/2019. Descriptive statistics and two-year incidence rates for validated operative nonunions were calculated by fusion level, fusion type, and levels fused. Time-dependent multivariable Cox-Proportional Hazards regression was used to evaluate operative nonunion rates with adjustment for covariates or risk change estimates more than 10%. We identified 2,061 patients (PLF:1491, ALIF+PS:570) with average follow-up time of 4.8(±3.1) years, and average time to operative nonunion 1.3(±1.2) yrs. Comparatively, single and multilevel incidence rates for nonunion were higher in PLF vs ALIF+PS: 1-Level: 0.9% (95% CI=0.4-1.6) vs 0.6% (95% CI=0.1-2.1); 2-Level: 2.0% (95% CI=0.8-4.0) vs 0.9% (95% CI=0.1-3.3). There were no observed differences in risk of operative nonunions in multivariable models comparing ALIF+PS vs PLF (HR=0.3, 95% CI=0.1-1.1), 1-level vs 2-level fusions (HR=1.8, 95% CI=0.8-4.3), or by fusion level (L4-L5: HR=1.0, 95% CI=0.4-2.7; L5-S1: HR=2.0, 95% CI=0.7-5.4). A large cohort of patients with >4 years follow-up found no difference in operative nonunions between PLF and ALIF+PS. Further research is warranted." @default.
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• W4248677588 date "2020-09-01" @default.
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• W4248677588 title "6. PLF or ALIF+PS: which has a lower operative nonunion rate? Analysis of a cohort of 2,061 patients from a national spine registry" @default.
• W4248677588 doi "https://doi.org/10.1016/j.spinee.2020.05.109" @default.
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