Rate Of Adjacent Segment Disease Research Articles

RE: TLIF is Associated With Lower Rates of Adjacent segment Disease and Complications Compared to ALIF.

RE: TLIF is Associated With Lower Rates of Adjacent segment Disease and Complications Compared to ALIF.

Comparison of minimally invasive transforaminal lumbar interbody fusion (Mis-TLIF) with bilateral decompression via unilateral approach and open-TLIF with bilateral decompression for degenerative lumbar diseases: a retrospective cohort study

ObjectivePresently, no study has compared the clinical outcomes of minimally invasive transforaminal lumbar interbody fusion (Mis-TLIF) with bilateral decompression via the unilateral approach (BDUA) and Open-TLIF with bilateral decompression for degenerative lumbar diseases (DLD). We aimed to compare the clinical outcomes of through Mis-TLIF combined with BDUA and Open-TLIF with bilateral decompression for the treatment of DLD, and reported the learning curve of the procedure of MIS-TLIF with BDUA.MethodsWe retrospectively analyzed the prospectively collected data of consecutive DLD patients in the two groups from January 2016 to January 2020.ResultsThe operative time (OT) was significantly longer in the Mis-TLIF group (n = 113) than in the Open-TLIF group (n = 135). The postoperative drainage volume (PDV) and length of stay (LOS) were significantly higher in the Open-TLIF group than in the Mis-TLIF group. Additionally, the complication rate was significantly higher in the Open-TLIF group than in the Mis-TLIF group (14.8% vs. 6.2%, P = 0.030), while there was no significant difference in the reoperation and adjacent segment disease rates between the two groups. There were no significant differences in back pain and leg pain Numerical Rating Scale (NRS) scores and Oswestry Disability Index (ODI) between the two groups preoperatively, at discharge, and 2 years postoperatively. Patients in both groups showed significant improvements in NRS scores and ODI scores after surgery. OT was negatively correlated with the number of surgeries performed (P < 0.001, r = −0.43). The learning curve of Mis-TLIF with BDUA was steep, with OT tapered to steady state in 43 cases.ConclusionCompared with Open-TLIF with bilateral decompression, Mis-TLIF with BDUA can achieve equivalent clinical outcomes, lower PDV and LOS, and lower complication rates. Although this procedure took longer, it could be a viable alternative for the treatment of DLD after a steep learning curve.

Limited Intervention in Adult Scoliosis-A Systematic Review.

Adult scoliosis is traditionally treated with long-segment fusion, which provides strong radiographic correction and significant improvements in health-related quality of life but comes at a high morbidity cost. This systematic review seeks to examine the literature behind limited interventions in adult scoliosis patients and examine the best approaches to treatment. This is a MEDLINE- and PubMed-based literature search that ultimately included 49 articles with a total of 21,836 subjects. Our search found that long-segment interventions had strong radiographic corrections but also resulted in high perioperative morbidity. Limited interventions were best suited to patients with compensated deformity, with decompression best for neurologic symptoms and fusion needed to treat neurological symptoms secondary to up-down stenosis and to provide stability across unstable segments. Decompression can consist of discectomy, laminotomy, and/or foraminotomy, all of which are shown to provide symptomatic relief of neurologic pain. Short-segment fusion has been shown to provide improvements in patient outcomes, albeit with higher rates of adjacent segment disease and concerns for correctional loss. Interbody devices can provide decompression without posterior element manipulation. Future directions include short-segment fusion in uncompensated deformity and dynamic stabilization constructs. Limited interventions can provide symptomatic relief to adult spine deformity patients, with indications mostly in patients with balanced deformities and neurological pain.

ALIF and TLIF Likely Have Similar Reoperation Rates: A Response to "TLIF is Associated With Lower Rates of Adjacent Segment Disease and Complications Compared With ALIF".

ALIF and TLIF Likely Have Similar Reoperation Rates: A Response to "TLIF is Associated With Lower Rates of Adjacent Segment Disease and Complications Compared With ALIF".

Ehlers-Danlos Syndrome is Associated with Increased Rates of Adjacent Segment Disease Following TLIF: A Propensity Matched Study

Ehlers-Danlos syndrome (EDS) is a collection of connective tissue disorders which are often associated with tissue laxity and disc degeneration. However, the implications of EDS on the risk of adjacent segment disease (ASD) after transforaminal lumbar interbody fusion (TLIF) are not well described. The objective of this study is to compare the rates of ASD among patients with EDS and those without EDS. Patients who underwent 1-3 level TLIF for degenerative disc disease between 2010-2022 were identified using the PearlDiver Mariner all-claims insurance database. Patients with all types of EDS were included. Patients undergoing surgery for tumors, trauma, or infection were excluded. 1:1 propensity matching was performed using demographic factors, medical comorbidities, and surgical factors which were significantly associated with ASD in a linear regression model. The primary outcome measure was the development of ASD. The secondary outcomes were the development of pseudoarthrosis, medical complications, and surgical complications. Propensity matching resulted in 2 equal groups of 85 patients who did or did not have EDS and underwent 1-3 level TLIF. Patients without EDS were less likely to experience ASD (RR 0.18, 95% CI 0.09-0.35, P < 0.001). There was no significant difference between the 2 patient groups with regards to a diagnosis of pseudoarthrosis, and there was no significant difference for all-cause medical and surgical complications between the 2 patient groups. After propensity matching to control for confounding variables, the findings of this study suggest that EDS may be associated with an increased risk of ASD following TLIF. Future studies are needed to corroborate these findings.

TLIF is Associated with Lower Rates of Adjacent Segment Disease and Complications Compared to ALIF: A Matched-Cohort Analysis.

Retrospective cohort. To compare the rate of adjacent segment disease (ASD) in patients undergoing anterior lumbar interbody fusion (ALIF) versus transforaminal lumbar interbody fusion (TLIF) for treatment of degenerative stenosis and spondylolisthesis. ALIF and TLIF are frequently used to treat Lumbar stenosis and spondylolisthesis. While both approaches have distinct advantages, it is unclear whether there are any differences in rates of ASD and postoperative complications. A retrospective cohort study of patients who underwent index 1-3 levels ALIF or TLIF between 2010-2022, using the PearlDiver Mariner Database, an all-claims insurance database (120 million patients). Patients with a history of prior lumbar surgery and those undergoing surgery for cancer, trauma, or infection were excluded. Exact 1:1 matching was performed using demographic factors, medical comorbidities, and surgical factors found to be significantly associated with ASD in a linear regression model. The primary outcome was a new diagnosis of ASD within 36 months of index surgery and secondary outcomes were all-cause medical and surgical complications. Exact 1:1 matching resulted in two equal groups of 106,451 patients undergoing TLIF and ALIF. The TLIF approach was associated with a lower risk of ASD (RR 0.58, 95% CI 0.56-0.59, P < 0.001), and all-cause medical complications (RR 0.94, 95% CI 0.91-0.98, P=0.002). All-cause surgical complications were not significantly different between both groups. After 1:1 exact matching to control for confounding variables, this study suggests that for patients with symptomatic degenerative stenosis and spondylolisthesis, a TLIF procedure (compared to ALIF) is associated with a decreased risk of developing ASD within 36 months of index surgery. Future prospective studies are needed to corroborate these findings. III.

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

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.

Complications in cervical total disc arthroplasty

Cervical total disc arthroplasty (CTDA) is an alternative to cervical fusion when addressing single level cervical disc disease and attempts to restore normal disc height and preserve motion, theoretically decreasing rates of adjacent segment disease (ASD) and symptomatic pseudoarthrosis. Although safe and effective, CTDA has a unique complication profile particularly in regard to long-term complications. Approach related complications are similar to anterior cervical discectomy and fusion (ACDF) and include injury to surrounding vascular, digestive, and neurologic structures. To achieve anatomic positioning, CTDA requires vertebral endplate cartilage removal and osseous preparation which can lead to endplate fracture, salvage fusion, or component malpositioning. Long term complications include heterotopic ossification (HO), implant subsidence, ASD requiring surgical intervention, and implant migration or translation. Although HO reduces motion at the prosthesis site, it does not appear to worsen clinical outcomes in most cases. Evidence is still conflicting regarding ASD when comparing ACDF to CTDA, however, the most recent evidence suggests a lower rate of development with CTDA.

Over level prophylactic flavectomy in lumbar fusion for degenerative spondylolisthesis: does it influence the rates of adjacent segment disease and clinical outcomes?

Over level prophylactic flavectomy in lumbar fusion for degenerative spondylolisthesis: does it influence the rates of adjacent segment disease and clinical outcomes?

Technical Note on Unilateral Biportal Lumbar Endoscopic Interbody Fusion

Unilateral biportal lumbar endoscopic interbody fusion is a relatively new technique in the field of minimally invasive spine surgery. It combines the benefits of preservation of the normal anatomy of the spine with direct visualization of the decompression of neural elements and endplate preparation for fusion. This results in high union rates and excellent outcomes for patients with back pain and lumbar spinal stenosis from spondylolisthesis while reducing the risk of injuries to the neural elements, endplate fractures and the theoretical rate of adjacent segment disease from disruption of the musculature. In this paper, we describe the steps and technical pearls pertaining to this technique and methods to avoid common pitfalls and complications. In conclusion, this technique would be a good tool in the armamentarium of a spinal surgeon specializing in minimally invasive spinal surgery.

No Significant Differences in Postoperative Complications Between Outpatient and Inpatient Single-level or Multiple-level Cervical Disk Replacement for Cervical Radiculopathy.

Retrospective cohort analysis. To investigate the safety profile of outpatient versus inpatient single-level and multiple-level cervical disk replacement (CDR) by analyzing one- and two-year surgical outcomes and 90-day medical complications using a large patient database. CDR is becoming a more desirable option for patients undergoing cervical spine procedures. Unlike anterior cervical diskectomy and fusion, CDR is motion-preserving and has been shown to reduce rates of adjacent segment disease. Current literature investigating outpatient versus inpatient CDR has shown a similar safety profile among the two cohorts. However, most of these studies have relatively small sample sizes with short-term follow-up. A retrospective cohort study was done using the PearlDiver patient database between 2010 and 2019. Patients who underwent single-level and multiple-level CDR with a follow-up of at least two years were identified. Patients within each procedure cohort were subdivided into an outpatient and an inpatient group. Univariate and multivariable analyses were performed. In total, 2294 patients underwent single-level CDR of which 506 patients underwent outpatient CDR and 1788 underwent inpatient CDR. In total, 236 patients underwent multiple-level CDR of which 49 patients underwent outpatient CDR and 187 underwent inpatient CDR. In the single-level CDR cohort, patients undergoing outpatient CDR were found to have lesser odds of a decompressive laminectomy at one year following the initial procedure (odds ratio=0.471; 95% confidence interval: 0.205-0.945; P =0.05). No significant differences in one- and two-year surgical complications, or 90-day postoperative complications, were found on multivariate analysis of outpatient versus inpatient multiple-level CDR. Our study found that performing single-level and multiple-level CDR on an outpatient basis has a similar safety profile to patients who underwent these procedures in an inpatient setting. 3.

Ultralong Follow-Up of Spinal Fusion for Adolescent Idiopathic Scoliosis: Harrington Instrumentation vs Uninstrumented Fusion.

Harrington instrumentation for adolescent idiopathic scoliosis (AIS) was revolutionary and allowed patients to mobilize faster as compared with patients treated with uninstrumented fusion. However, Harrington instrumentation provided correction of the deformity in 1 plane, resulting in limited sagittal plane control. Patients who received these 2 surgeries are aging, and to date, ultralong follow-up of these patients has not been reported. The purpose of this study was to evaluate long-term patient-reported outcomes and radiographic parameters after Harrington nonsegmental distraction instrumentation vs uninstrumented fusion in the treatment of AIS. Fourteen adult patients with AIS who were previously instrumented (n = 7) or uninstrumented (n = 7) were identified. Recent x-ray image measurements such as pelvic incidence (PI), sagittal vertical axis (SVA), pelvic tilt (PT), lumbar lordosis (LL), and pelvic incidence minus lumbar lordosis (PI-LL) were used to analyze deformities. Scoliosis Research Society-7 (SRS-7), Neck Disability Index (NDI), and Oswestry Disability Index (ODI) were used to evaluate patient-reported outcomes. Complications and rates of revision surgery were also evaluated. The mean age was 67.1 ± 5 years in the instrumented group and 64.1 ± 9 years in the uninstrumented group. There were no significant differences between instrumented and uninstrumented in SRS-7 (23.4 ± 2.9 vs 23.6 ± 2.6, P = 0.93), NDI (5.7 ± 4.5 vs 10.6 ± 4.5, P = 0.08), and ODI (9.7 ± 13.7 vs 9.4 ± 8.7, P = 0.99). Radiographic measurements of instrumented vs uninstrumented resulted in comparable PT (24.0 ± 7.9 vs 30.5 ± 4.7, P = 0.09), PI (61.3 ± 16.9 vs 67.2 ± 9.5, P = 0.47), LL (34.9 ± 14.4 vs 42.8 ± 11.0, P = 0.29), PI-LL (26.4 ± 25.1 vs 24.3 ± 10.4, P = 0.43), and SVA (38.1 ± 30.1 vs 52.3 ± 21.6, P = 0.37). There were 2 patients in the instrumented group who developed adjacent segment disease that required operative intervention compared with none in the uninstrumented group (P = 0.46). In long-term follow-up of instrumented and uninstrumented fusion, patients had similar patient-reported outcomes and radiographic parameters, although the instrumented cohort had higher rates of adjacent segment disease.

Comparison of minimally invasive and open TLIF outcomes with more than seven years of follow-up

BackgroundFew studies directly comparing minimally invasive (MI) transforaminal lumbar interbody fusion (TLIF) and open TLIF offering long-term follow-up data have been performed to date. Therefore, we sought to compare mid- to long-term outcomes between these two surgical approaches. MethodsThis was a retrospective data analysis of two surgical groups. We analyzed the details of 97 patients with degenerative lumbar disease who were treated with MI TLIF (n = 55) or open TLIF (n = 42) between 2011–2014 and had at least seven years of follow-up data available. Peri- and postoperative outcomes were compared. To evaluate rates of adjacent segment disease (ASD) and revisions, frequencies of radiologic, symptomatic, and operative ASD were analyzed accordingly. ResultsIn terms of clinical outcome, the Oswestry Disability Index and visual analog scale scores were significantly reduced, with no difference between the groups. However, data for several peri- and postoperative outcomes, including perioperative blood loss, ambulation day, hospital stay, and operation time, varied in a manner favoring the MI TLIF group (P < 0.05). Rates of radiologic ASD and symptomatic ASD were significantly higher in the open TLIF group beginning at five years of follow-up (P < 0.05), while the rate of operative ASD and the revision rate were similar between the groups. Other long-term outcomes, including fusion rate and complications, remained similar between the two groups at 7 years. ConclusionPatients undergoing MI TLIF showed favorable immediate postoperative outcomes and less radiographic ASD. However, the rates of fusion and operative ASD remained similar between the two groups after 7 years of follow-up.

Negative impact of short-level posterior lumbar interbody fusion in patients with diffuse idiopathic skeletal hyperostosis extending to the lumbar segment.

The development of diffuse idiopathic skeletal hyperostosis (DISH) often requires further surgery after posterior decompression without fusion because of postoperative intervertebral instability. However, there is no information on whether fusion surgery is recommended for these patients as the standard surgery. The aim of this study was to review the clinical and imaging findings in lumbar spinal canal stenosis (LSS) patients with DISH affecting the lumbar segment (L-DISH) and to assess the indication for fusion surgery in patients with DISH. A total of 237 patients with LSS underwent 1- or 2-level posterior lumbar interbody fusion (PLIF) at the authors' hospital and had a minimum follow-up period of 2 years. Patients with L-DISH were classified as such (n = 27, 11.4%), whereas those without were classified as controls (non-L-DISH; n = 210, 88.6%). The success rates of short-level PLIF were compared in patients with and those without L-DISH. The rates of adjacent segment disease (ASD), pseudarthrosis, postoperative symptoms, and revision surgery were examined in the two groups. L-DISH from L2 to L4 correlated significantly with early-onset ASD, pseudarthrosis, and the appearance of postsurgical symptoms, especially at a lower segment and one distance from the segment adjacent to L-DISH, which were associated with the worst clinical outcome. Significantly higher percentages of L-DISH patients developed ASD and pseudarthrosis than those in the non-L-DISH group (40.7% vs 4.8% and 29.6% vs 2.4%, respectively). Of those patients with ASD and/or pseudarthrosis, 69.2% were symptomatic and 11.1% underwent revision surgery. The results highlighted the negative impact of short-level PLIF surgery for patients with L-DISH. Increased mechanical stress below the fused segment was considered the reason for the poor clinical outcome.

Recurrent lumbar disk herniation – Fusion is the answer

Recurrent lumbar disk herniations (rLDHs) are becoming a common occurrence in present times. However, the optimal surgical strategy for their management is a not clear with discectomy alone and discectomy followed by fusion emerging as the main surgical options. In this editorial debate, we discuss why discectomy and fusion is better option for the management of such cases. The complication rates, treatment satisfaction rates, visual analog scale (VAS) leg pain scores, and rates of adjacent segment disease (ASD) requiring surgery are similar in both the groups. However, the back pain score and reoperation rates are better in fusion surgeries. Moreover, the problems needing reoperations (hardware problems and ASD) in fusion group are easier to treat. Fusion surgery is already indicated in rLDH cases with deformity, instability, and significant axial low back pain. We believe it should be considered in all cases due to negligible risk of recurrence, addressing the iatrogenic spinal instability caused due to extensive bony work, ease of surgery due to more working space, and better restoration of disk height and sagittal balance.

Fusing to the Sacrum/Pelvis: Does the Risk of Reoperation in Thoracolumbar Fusions Depend on Upper Instrumented Vertebrae (UIV) Selection?

There is controversy as to whether fusions should have the upper instrumented vertebrae (UIV) end in the upper lumbar spine or cross the thoracolumbar junction. This study compares outcomes and reoperation rates for thoracolumbar fusions to the sacrum or pelvis with UIV in the lower thoracic versus lumbar spine to determine if there is an increased reoperation rate depending on UIV selection. A retrospective review of prospectively collected data was conducted from a single-center database on adult patients with degeneration and deformity who underwent primary and revision fusions with a caudal level of S1 or ilium between 2012 and 2018. Fusions were classified as anterior, posterior, or combination approach. Revision fusions included patients who had spinal surgery at another institution prior to their revision surgery at the center. Patients were categorized into 1 of 3 groups based on UIV: T9-T11, upper lumbar region (L1-L2), and lower lumbar region (L3-L5). Inclusion criteria were age 18 years or older and at least 1 year of clinical follow-up. Patients were excluded from analysis if they had tumors, infections, or less than 1 year of follow-up after the index procedure. The reoperation rates for the UIV groups in the thoracic (28%) and upper lumbar (27%) spine were nearly equal in magnitude and were both significantly higher than the reoperation rate in the lower lumbar group (18%, P = .046). Reoperation for the diagnosis of adjacent segment disease was 8.3% in the upper lumbar spine and statistically significantly higher than the reoperation rates for adjacent segment disease in the thoracic (1%) or lower lumbar (4.5%, P = .042) spine. Reoperations for pseudoarthrosis and proximal junctional kyphosis were 13% and 4%, respectively, in the thoracic spine, both of which were statistically significantly different (pseudoarthrosis, P = .035; proximal junctional kyphosis, P = .002) from the reoperation rates for the same diagnoses in the upper lumbar spine (4.6% and 1%) or lower lumbar spine (6.2% and 0%). A multivariate logistical regression model at 2-year follow up did not show a statistically significant difference between reoperation rates between the thoracic and upper lumbar spine UIV groups. Constructs with UIV in the thoracic spine suffer from higher rates of proximal junctional kyphosis and pseudoarthrosis, whereas those with UIV in the upper lumbar spine have higher rates of adjacent segment disease. Given this tradeoff, there is no certain recommendation on what UIV will result in a lower reoperation rate in thoracolumbar fusion constructs to the sacrum or pelvis. Surgeons must evaluate patient characteristics and risks to make the optimal decision.

161. Metal-on-metal vs metal-on-plastic artificial discs in 2-level anterior cervical disc replacement: a meta-analysis with follow up of 5 years or more

<h3>BACKGROUND CONTEXT</h3> Anterior cervical discectomy and fusion (ACDF) is a well-established procedure that has long been considered the standard treatment for degenerative disc disease (DDD). Despite positive clinical outcomes, accelerated rates of adjacent segment disease (ASD) in ACDF, especially in two-level surgery, has led spinal surgeons to increasingly use anterior cervical disc replacement (ACDR) as an alternative. However, long-term success may be limited by the properties inherent to the devices utilized. The use of metal-on-metal (MM) bearings in total joint replacement, for example, has been hypothesized to significantly decrease volumetric wear rates, but subsequent complications associated with metallosis have prompted joint surgeons toward using metal-on-plastic (MP) or ceramic implants more commonly. Furthermore, MP implants in total hip arthroplasty have been associated with superior clinical outcomes and durability when compared to MM implants. Although highlighted in joint arthroplasty studies, long-term outcomes between differing biomaterial composites in ACDR have not been thoroughly investigated. <h3>PURPOSE</h3> The purpose of this study was to evaluate the rates of ASD, reoperation rates, complications and patient reported clinical outcomes of MM vs MP artificial discs in two-level ACDR for the treatment of cervical DDD. <h3>STUDY DESIGN/SETTING</h3> Meta-analysis and systematic review. <h3>PATIENT SAMPLE</h3> A total of 980 patients (442 MM, 538 MP). <h3>OUTCOME MEASURES</h3> 1) Rate of ASD, 2) reoperation rate, 3) complications, 4) patient reported clinical outcomes (NDI, VAS-neck, VAS-arm). <h3>Methods</h3> A systematic search strategy of three electronic databases (PubMed, CINAHL Plus and SCOPUS) was conducted utilizing terms related to 2-level ACDR. All studies included were published in the past 5 years, had a sample size of >10 patients, and reported data on adjacent segment disease. Cadaver studies, non-English manuscripts and studies in which only single-level ACDR was investigated were excluded. A total of 7 studies were included in this analysis. Studies were analyzed for demographic data, clinical outcome scores (NDI, VAS-neck and VAS-arm), rates of ASD, complications and reoperation proportions. A random-effects model of meta-analysis was used for groups that were determined to be heterogenous and a fixed-effects model was utilized for groups that were not. An overlap of 95% confidence intervals suggests no statistically significant difference at the p<0.05 level. <h3>Results</h3> Seven studies were included with data on 980 patients (442 MM, 538 MP). The study population was 52.84% female, with a mean age of 48.01 years, and a mean follow-up of 85.66 months. The mean improvement in NDI was 34.42 (95% CI, 32.49-36.36) and 29.72 (95% CI, 27.15-32.29) for the MM and MP groups, respectively. The mean improvement in VAS-neck was 11.20 (95% CI, 10.69-11.70) and 8.78 (95% CI, 7.81-9.74) for the MM and MP groups, respectively. The mean improvement in VAS-arm was 10.73 (95% CI, 9.83-11.63) and 8.49 (95% CI, 7.59-9.39) for the MM and MP groups, respectively. Reoperation was needed in 1.36% (95% CI, 0.61-2.99) of patients who underwent ACDR with an MM implant compared to 5.33% (95% CI, 3.68-7.65) of patients with an MP implant. The MM cohort had a larger proportion of patients with ASD who underwent subsequent surgery at an adjacent level (7.89% MM vs 1.91% MP). Heterotopic ossification and dysphagia were the most common complications in both groups, and the incidence of each was significantly higher in the MP cohort. <h3>Conclusions</h3> Our present meta-analysis suggests that the use of MM artificial discs in 2-level ACDR results in superior clinical outcome scores with a lower complication profile and reoperation rate, but higher rates of ASD compared to MP discs after a follow-up period of 5 years or more. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

117. Minimally invasive transforaminal lumbar interbody fusion increases late-term rates of pseudarthrosis versus open approach

<h3>BACKGROUND CONTEXT</h3> Lumbar fusion has developed into an effective surgical treatment option for patients with various lumbar pathologies including discogenic pain, stenosis and spinal instability. Popular minimally-invasive (MI) fusion techniques, such as transforaminal lumbar interbody fusion (TLIF) have been increasingly utilized by spinal surgeons, offering similar clinical outcomes to traditional open approaches and often reporting decreased blood loss and complications in the long term. Despite a number of reports comparing open versus MI-TLIF, literature stratifying return to OR (RTO) complications between the two approaches by time after surgery is limited. Therefore, the purpose of this study was to determine the differences in early, late and long-term revision rates between open and MI-TLIF. <h3>PURPOSE</h3> To determine differences in early, late and long-term revision rates between MI and open TLIF. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort study. <h3>PATIENT SAMPLE</h3> This study included 423 consecutive patients from 2012-2018 with a minimum follow-up of 2 years. Of the total, 127 underwent open TLIF and 296 underwent MI-TLIF. <h3>OUTCOME MEASURES</h3> (1) Return to OR revision rate, (2) pseudarthrosis proportion, (3) ASD proportion. <h3>Methods</h3> A retrospective review was performed to identify all patients between 2012-2018 who underwent 1- or 2-level open or MI-TLIF with a minimum follow-up of 2 years. Demographic data were compared between groups. RTO complications were noted and grouped according to categories related to infection, neurologic, fusion status, hardware and global alignment. These complications were then stratified by early (<6 months), late (6 months-2 years), and long-term (>2 years) time periods. Standard binominal and categorical comparative analyses were performed. <h3>Results</h3> A total of 423 consecutive patients were included; 127 in the open TLIF cohort and 296 in the MI-TLIF cohort. There were 67 males and 60 females in the open TLIF group compared to 177 males and 119 females in the MI-TLIF group (p= 0.180). Mean age was 54.1 years (21.9-79.2). Mean follow-up for the open TLIF and MI-TLIF groups were 67.9 and 69.6 months, respectively (p= 0.633). The overall RTO rate was 10.8% in the MI-TLIF cohort and 11.8% in the open TLIF cohort (p= 0.764). The open TLIF cohort had a significantly lower incidence of pseudarthrosis requiring RTO at the late-term time point (p= 0.042). There were no significant differences with respect to rates of adjacent segment disease (ASD) or any other particular complication requiring RTO. RTO rates at respective time points were 2.4%, 5.7%, and 2.7% for the MI-TLIF group and 5.5%, 0.8%, and 5.5% for the open TLIF group. Subgroup analysis of single-level operations only (75 open TLIF vs 255 MI-TLIF) demonstrated a significantly lower incidence of pseudarthrosis and ASD at both the late- and long-term time points (p= <0.001) in the open TLIF cohort, with no significant differences between overall RTO rates or any other complication (p= 0.333). <h3>Conclusions</h3> Open and MI-TLIF have both been shown to provide equivalent long-term clinical outcomes. In this study, patients undergoing open TLIF had significantly lower rates of pseudarthrosis compared to MI-TLIF. Open TLIF should be considered in patients with risk factors for nonunion; however, larger cohort studies are required to corroborate these findings. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Comparing Anterior Cervical Discectomy Fusion with Cervical Disc Arthroplasty in Cervical Spondylosis

The present article reviews updated research, patient selection, complications associated with types of cervical disc implants, and its use in patients with multilevel cervical spondylosis. Recent metanalysis comparing Cervical Disc Arthroplasty (CDA) and Anterior Cervical Discectomy and Fusion (ACDF) has demonstrated safety and equal or superior clinical outcomes based on SF-36 NDI and VAS scores. Recent studies show similar outcomes for using CDA in two-level cervical disc disease of those suffering radiculopathy and/or /myelopathy. Long-term studies are more available to show decreased rates of adjacent segment disease and reoperation rates following cervical disc replacement. Cervical arthroplasty continues to be a promising technique for which now there is growing level 1a evidence. Further long-term data is awaited to investigate two-level CDA and reoperation rates specifically due to adjacent level disease, subsidence, implant migration, and heterotropic ossification.

48. Fusion and decompression vs decompression only for lumbar facet cysts

BACKGROUND CONTEXT Lumbar facet cysts are associated with radiculopathy, neurogenic claudication and higher risk of dural tears. Consensus on the best method to address these lesions is lacking (fusion vs decompression only). Outcomes after surgery are of increasing interest to spine surgeons, particularly when seeking to offer the most conservative, yet effective, option. Our objective is to describe complications, outcomes and recurrence rates following surgical intervention of facet cysts. PURPOSE To evaluate surgical outcomes of facet cyst treatment. STUDY DESIGN/SETTING Retrospective cohort PATIENT SAMPLE Patients with lumbar facet cyst treated at a single site by multiple surgeons between 2009 and 2017. OUTCOME MEASURES Revision surgeries, estimated blood loss, adjacent segment disease, length of hospital stay. METHODS A retrospective analysis of patients diagnosed with lumbar facet cysts who underwent treatment for their condition at a single academic tertiary care facility between 2008 and 2018. Patients underwent surgical treatment (fusion + decompression [DF] or decompression only [DO]). All patients were evaluated for surgical approach, facet cyst level, postop complication, cyst recurrence, EBL and length of hospital stay. Adjacent segment disease rates were also assessed. RESULTS A total of 140 patients were assessed. Mean age was 63.4 (43-93) including 80F and 60M. A total of 114 underwent DO and 26 patients underwent DF. The majority of the cysts 56% (n=78) were at L4-L5, followed by 24% (n=34) at L5-S1, 16% (n=22) at L3-L4 and 4% (n=6) at L2-L3. The recurrence rate in the DO group was 8% (9/114) as compared to 0 in the DF (p CONCLUSIONS Patients who undergo DF have an increased risk of adjacent segment degeneration but decreased rate of recurrence. The rate of cyst recurrence is higher among those treated by decompression alone; however, adjacent segment disease, blood loss, and length of hospital stay are lower. Four patients treated initially with DO underwent revision procedures with fusions after cyst recurrence. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.