title: 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.
abstract: Few studies have measured outcome differences between the various available spinal fusion techniques. We compare long-term outcomes of anterior versus 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, p<0.0001), although differences became non-significant at maximum follow-up (p=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, p<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, p<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.
authors.affiliation: Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Kevin T
authors.initials: KT
authors.lastname: Huang
authors.affiliation: Division of Neurosurgery, Duke University Medical Center, Box 3807, Durham, NC 27710, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hazzard
authors.affiliation: Division of Neurosurgery, Duke University Medical Center, Box 3807, Durham, NC 27710, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Thomas
authors.affiliation: Division of Neurosurgery, Duke University Medical Center, Box 3807, Durham, NC 27710, USA.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Chagoya
authors.affiliation: Division of Neurosurgery, Duke University Medical Center, Box 3807, Durham, NC 27710, USA.
authors.forename: Rand Wilcox Vanden
authors.initials: RW
authors.lastname: Berg
authors.affiliation: Division of Neurosurgery, Duke University Medical Center, Box 3807, Durham, NC 27710, USA.
authors.forename: Owoicho
authors.initials: O
authors.lastname: Adogwa
authors.affiliation: Division of Neurosurgery, Duke University Medical Center, Box 3807, Durham, NC 27710, USA.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Bagley
authors.affiliation: Division of Neurosurgery, Duke University Medical Center, Box 3807, Durham, NC 27710, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Isaacs
authors.affiliation: Division of Neurosurgery, Duke University Medical Center, Box 3807, Durham, NC 27710, USA.
authors.forename: Oren N
authors.initials: ON
authors.lastname: Gottfried
authors.affiliation: Division of Neurosurgery, Duke University Medical Center, Box 3807, Durham, NC 27710, USA. Electronic address: nandan.lad@duke.edu.
authors.forename: Shivanand P
authors.initials: SP
authors.lastname: Lad
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology; D057216:Propensity Score; D012086:Reoperation / Q000379:methods / Q000639:trends; D013123:Spinal Fusion / Q000009:adverse effects* / Q000379:methods* / Q000639:trends; D016896:Treatment Outcome
keywords: Lumbar vertebrae; Postoperative complications; Reoperation; Spinal fusion; Treatment outcome