Fusion Technique Does Not Affect Short-Term Patient Reported Outcomes for Lumbar Degenerative Disease

Abstract 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 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.