278 Lateral Anterior Column Release in Short Construct... Is It Worth It?

Abstract

INTRODUCTION: Adjacent Segment Disease (ASD) is a common complication after lumbar spinal fusions. Ways to reduce the rates for ASD are highly sought after mainly to avoid re-operation. METHODS: We conducted a retrospective cohort study that consisted of patients that underwent 1-2 level LLIF for degenerative spine disease from 2014-2020. Patients needed to have at least one year of follow-up and have postoperative standing x-rays. Preoperative demographics, perioperative surgical characteristics, and postoperative outcomes were recorded. RESULTS: 92 patients were included for analysis after inclusion criteria. Median follow-up period of 25 months. 54% F, 64 years of age, BMI 31. 11 patients (12%) developed ASD at a median follow up of 29 months. In the patients with ASD, 9 (82%) underwent anterior column release (ACR) with the placement of hyper-lordotic cages > 20 degrees. In our cohort of short construct LLIF ACR was done 9 patients (L3/4 (7 patients) and L4/5 (2 patients). In the univariate analysis we found that age-adjusted PI-LL mismatch (p < 0.003), the use of a hyperlordotic cage (p = 0.003), and ACR release (p < 0.001) were significantly associated with ASD. A multivariate logistic regression model was created and showed only that ACR was predictive for ASD (Odds Ratio: 69.1, 95% confidence interval: 10.71-446.3, p < 0.001). CONCLUSIONS: ACR was predictive for developing ASD in lumbar degenerative disease patients that undergo short-segment LLIF. While other factors may play a role, this was the predominant factor identified in our cohort with at least 10-fold increase risk. ACR is a powerful tool to be use in only spinal deformity. We recommend against ACR in short construct LLIF.