title: Complications and Rates of Subsequent Lumbar Surgery Following Lumbar Total Disc Arthroplasty and Lumbar Fusion.
abstract: METHODS
  Retrospective analysis.
  
  
  OBJECTIVE
  To examine complications and rates of subsequent surgery following lumbar spinal fusion (LF) and lumbar total disc arthroplasty (TDA) at up to 5-year follow-up.
  
  
  BACKGROUND
  LF is commonly used in the management of degenerative disc disease causing pain refractory to nonoperative management. Lumbar TDA was developed as an alternative to fusion with the theoretical advantage of reducing rates of adjacent segment pathology and reoperation. Most prior reports comparing these 2 interventions have come from industry-sponsored investigational device exemption trials and no large-scale administrative database comparisons exist.
  
  
  METHODS
  The California Office of Statewide Health Planning and Development discharge database was queried for patients aged 18 to 65 years undergoing lumbar TDA and LF for degenerative disc disease from 2004 to 2010. Patient characteristics were collected, and rates of complications and readmission were identified. Rates of repeat lumbar surgery were calculated at 90-day and 1-, 3-, and 5-year follow-up intervals.
  
  
  RESULTS
  A total of 52,877 patients met the inclusion criteria (LF = 50,462, TDA = 2415). Wound infections were more common following LF than TDA (1.03% vs. 0.25%, P < 0.001). Rates of subsequent lumbar surgery at 90-day and 1-year follow-up were lower with lumbar TDA than LF (90-day-TDA: 2.94% vs. LF: 4.01%, P = 0.007; 1-yr-TDA: 3.46% vs. LF: 4.78%, P = 0.009). However, there were no differences in rates of subsequent lumbar surgery between the 2 groups at 3-year and 5-year follow-up.
  
  
  CONCLUSIONS
  Lumbar TDA was associated with fewer early reoperations, though beyond 1 year, rates of reoperation were similar. Lumbar TDA may be associated with fewer acute infections, though this may be approach related and unrelated to the device itself.
  
  
  METHODS
  3.
authors.affiliation: *Department of Orthopaedic Surgery, University of California at Los Angeles, Los Angeles, CA †Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO ‡Department of Orthopaedic Surgery, University of California at Los Angeles, Los Angeles, CA §Department of Orthopaedic Surgery, University of California at Los AngelesLos Angeles, CA.
authors.forename: Claire D
authors.initials: CD
authors.lastname: Eliasberg
authors.forename: Michael P
authors.initials: MP
authors.lastname: Kelly
authors.forename: Remi M
authors.initials: RM
authors.lastname: Ajiboye
authors.forename: Nelson F
authors.initials: NF
authors.lastname: SooHoo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001696:Biomechanical Phenomena; D002140:California; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000503:physiopathology / Q000601:surgery*; D055959:Intervertebral Disc Degeneration / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013123:Spinal Fusion / Q000009:adverse effects*; D013997:Time Factors; D059145:Total Disc Replacement / Q000009:adverse effects*; D016896:Treatment Outcome; D055815:Young Adult