Differences in the outcomes of anterior versus posterior interbody fusion surgery of the lumbar spine: A propensity score-controlled cohort analysis of 10, 941 patients. Issue 5 (May 2015)

• Record Type: Journal Article
• Authors: Huang, Kevin T.; Hazzard, Matthew; Thomas, Steven; Chagoya, Gustavo; Berg, Rand Wilcox Vanden; Adogwa, Owoicho; Bagley, Carlos A.; Isaacs, Robert; Gottfried, Oren N.; Lad, Shivanand P.
• Is Part Of: Journal of clinical neuroscience. Volume 22:Issue 5(2015:May)
• Page Start: 848
• Page End: 853
• Publication Date: 2015-05
• Subjects: Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2014.11.016
• Languages: English
• ISSNs: 0967-5868

Abstract

<abstract xml:lang="en" abstract-type="author" id="ab005"> <title id="st055">Abstract</title> <sec> <p id="sp0005">Few studies have measured outcome differences between the various available spinal fusion techniques. We compare long-term outcomes of anterior <italic>versus</italic> posterior lumbar interbody fusion. Using the MarketScan database (Truven Health Analytics, Ann Arbor, MI, USA) we selected patients ⩾18 years old who underwent lumbar fusion surgery from 2000–2009 using either approach. Exclusion criteria included circumferential fusion, and having less than 1 year of preoperative or less than 2 years of postoperative follow-up. Using an inverse probability-weighted propensity-score model we compared reoperation and 90 day complication rates, and postoperative health resource utilization of both approaches. A total of 10, 941 patients were identified. Of these, 7460 (68.2%) and 3481 (31.8%) underwent posterior and anterior interbody fusion, respectively. Anterior fusion patients had a higher 2 year reoperation rate (odds ratio 1.43, 95% confidence interval [CI]: 1.21–1.70, <italic>p</italic> < 0.0001), although differences became non-significant at maximum follow-up (<italic>p</italic> = 0.0877). The 90 day complication rate was 15.7%, with anterior fusion patients being more likely to experience complications (relative risk 1.24, 95%CI: 1.13–1.36, <italic>p</italic> < 0.0001). Anterior fusion patients also had greater levels of postoperative health utilization, surpassing posterior fusion patients by an average of $US7450 in total charges (95% CI: $4670–$10, 220, <italic>p</italic> < 0.0001). As currently practiced in the USA, anterior lumbar surgical approaches may be associated with higher postoperative morbidity and reoperation rates than posterior fusion approaches.</p> </sec> </abstract>