Comparison of patient outcomes of anterior and posterior lumbar interbody fusions: A retrospective national database analysis

Abstract

Background

Lumbar interbody fusions are used to treat degenerative lumbar disease unresponsive to conservative treatment. This procedure may be divided into anterior lumbar interbody fusion (ALIF), and posterior lumbar interbody fusion (PLIF/TLIF). Despite their widespread use, comparative research on their outcomes remains limited.

Methods

The PearlDiver Database was utilized to identify patients undergoing single and multi-level ALIF and PLIF/TLIF between 2010 and 2022. We examined demographic data, comorbidities, and reoperation rates at 90 days, 1 year, and 2 years. Complications were assessed using multivariable regression to adjust for confounders.

Results

The study included multi-level anterior interbody fusions (N = 569, mean age 59.8, 59 % female), multi-level posterior interbody fusions (N = 43,651, mean age 57.9, 60 % female), single-level anterior interbody fusions (N = 3,547, mean age 55.3, 61 % female) and single-level posterior interbody fusions (N = 25,792, mean age 56.9, 62 % female). Multi-level posterior interbody fusion patients had a lower prevalence of HTN (OR .77, P < .05), ischemic heart disease (OR .73, P < .05), CDK (OR .77, P < .05), postoperatively more DVTs (OR 1.44, P < .05), a lower incidence of respiratory failure (OR .57, P < .05), and a higher 90-day, 1-year, and 2-year all-cause reoperation rate (7.3 %) compared to multi-level anterior interbody fusion patients (3.7 %). Single-level posterior interbody fusion patients had more HTN (OR 1.1, P < .05), less ischemic heart disease (OR .89, P < .05), obesity (OR .92, P < .05), and postoperatively a higher incidence of DVT (OR 1.34, P < .05) but lower 90-day, 1-year, and 2-year all-cause reoperation rates.

Conclusions

This study confirms that posterior interbody fusions are more common than anterior procedures, though the latter is increasing. Reoperation rates are higher for multi-level posterior and single-level anterior fusions. Both anterior and posterior approaches show similar complication profiles, though specific risks, such as postoperative DVT, vary. These findings emphasize the need for ongoing research and consideration of individual patient factors when choosing an interbody fusion technique.