Ten-Year Delayed Reoperation Following Single-Level Lumbar Total Disc Replacement Versus Stand-Alone Lumbar Interbody Fusion

Study Design: Retrospective cohort study of patients undergoing single-level lumbar interbody fusion or total disc replacement (TDR). Objective: The purpose of this study is to compare delayed reoperation, postoperative complications, and health care utilization following single-level lumbar TDR versus stand-alone anterior/lateral lumbar interbody fusion (ALIF/LLIF). Summary of Background Data: Although prior studies have reported favorable clinical outcomes and lower rates of adjacent segment pathology following lumbar TDR, long-term comparative evidence evaluating delayed reoperation remains limited and inconsistent. Materials and Methods: This study was performed following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines through the PearlDiver Mariner 8 data set. Patients undergoing lumbar TDR were matched to those undergoing ALIF/LLIF for age, sex, Elixhauser comorbidity index (ECI), obesity, tobacco use, diabetes mellitus, osteoporosis, opioid use, insurance plan, region, and surgical year. Statistical significance was defined as P <0.05. Results: A total of 1249 TDR patients were matched to 4684 ALIF/LLIF patients. At one year postoperatively, the TDR cohort had a lower risk of pulmonary embolism (RR: 0.37, 95% CI: 0.13–1.02; P =0.04) and dural injury (RR: 0.18, 95% CI: 0.04–0.76; P =0.004). At two-years postoperatively, the TDR cohort had a lower risk of pulmonary embolism (RR: 0.37, 95% CI: 0.15–0.92; P =0.02), pneumonia (RR: 0.66, 95% CI: 0.45–0.98; P =0.04) and dural injury (RR: 0.18, 95% CI: 0.04–0.74; P =0.005). At 90 days postoperatively, total reimbursement was lower for the TDR cohort (SMD: −0.069, 95% CI: −0.133 to −0.006; P =0.02). There were no differences in delayed reoperation. Conclusion: Single-level lumbar TDR was not associated with lower delayed reoperation rates compared with stand-alone ALIF/LLIF through 10 years of follow-up. Although TDR demonstrated selected early perioperative advantages, these findings did not translate into improved long-term surgical durability or health care utilization. Level of Evidence: Level III—retrospective cohort study.