Lumbar Arthroplasty is Associated with a Lower Incidence of Adjacent Segment Disease Compared to ALIF: A Propensity Matched Analysis.

Abstract

Retrospective Cohort Study. To compare the rate of ASD between lumbar disc arthroplasty (LDA) and anterior lumbar interbody fusion (ALIF). Lumbar disc arthroplasty (LDA) and anterior lumbar interbody fusion (ALIF) are alternative surgical approaches used to treat lumbar degenerative disc disease. However, there is a paucity of studies comparing the risk of adjacent segment disease (ASD) following these procedures. Patients who underwent 1-2 level LDA or ALIF between 2010 and 2022 were identified in the PearlDiver Mariner insurance all-claims database. Exclusion criteria included history of prior lumbar spine surgery, or surgery for tumors, trauma, or infection. 1:1 propensity matching was performed using demographic factors, medical comorbidities, and surgical factors which were significantly associated with ASD. 1:1 Propensity matching created two equal groups of 1,625 patients without baseline differences who underwent LDA or ALIF. LDA was significantly associated with a lower risk of ASD (RR 0.932, 95% CI 0.899-0.967, P<0.001), and need for revision within 30 days (RR 0.235, 95% CI 0.079-0.698, P=0.007). There were no differences in all-cause surgical and medical complications between both groups. After risk adjustment for demographic and clinical characteristics, the results suggest that LDA is associated with a lower risk of adjacent segment disease compared to ALIF. LDA was also associated with lower hospital cost and shorter length of stay.