Background/Objectives: To identify predictors of successful fusion and adjacent segment disease (ASD) following ALIF. Methods: Records of patients undergoing one- or two-level ALIF were queried for baseline and postoperative radiographic data, demographics, operative notes, and implant characteristics. All had ≥1 year of follow-up with CT, and multivariable Cox regression was used to identify predictors of radiographic fusion through the interbody, ASD, and ASD requiring reoperation. Results: In total, 177 patients (median 59 yr; 52.5% male) were treated at 245 unique levels, of which 193 fused (81.3% with posterior fixation and 59.6% with standalone), 43 had ASD (17.6%), and 14 had ASD requiring reoperation (5.7%). Fusion was predicted by anterior cage placement (HR 0.94/mm; 95% CI 0.90, 0.98; p = 0.003) and BMP use (HR 1.92; 1.15, 3.18; p = 0.012). Radiographic ASD was predicted by older age (HR 1.08 per year; 1.03, 1.14; p < 0.001), undergoing a revision vs. index fusion operation (HR 3.51; 1.44; 8.59; p = 0.006), lower preoperative disc height (HR 0.83/mm; 0.74, 0.94; p = 0.003), and preoperative facet vacuum phenomenon (HR 2.46; 1.18, 5.15; p = 0.017). None of the extracted variables predicted reoperation for ASD. Conclusions: BMP use along with anterior cage placement and posterior fixation may improve the odds of fusion through the interbody following one- or two-level ALIF. Adjacent segment pathology is more common in patients with greater preoperative degenerative pathology (vacuum sign; more collapsed disc) and advanced age. Pelvic fixation did not improve fusion odds, but the data highlight the benefits of supplementary posterior fixation vs. standalone ALIF.
Pennington et al. (Sat,) studied this question.
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