Neuro-Chirurgie · 2026
Single-level anterior lumbar interbody fusion versus lumbar disc arthroplasty in the young adult patient population: a propensity-matched cohort analysis.
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Ferdon Robert J, Ravinsky Robert A, Lawrence James P, Reitman Charles A, Silvestre Jason
Аннотация
BACKGROUND: There is a paucity of long-term studies investigating the benefits of lumbar disc arthroplasty (LDA). This study compared the short- and long-term complication profiles following LDA versus anterior lumbar interbody fusion (ALIF) in young adult patients.
METHODS: A multi-institutional electronic health record database was queried for adult patients between 18 and 50 years of age undergoing single-level LDA or ALIF. Exclusion criteria were history of spine surgery, multiple level surgery, spine neoplasms, trauma, inflammatory, or infectious bone conditions. Comparisons were made with independent sample t-tests and odds ratios for complications were calculated at 30 days, two-years, and five-years.
RESULTS: Patients at a mean age of 41 ± 9 years (n = 1,156) were evenly divided into both cohorts. At thirty days, there were similar rates of medical complications between patients undergoing LDA and ALIF. Patients undergoing ALIF had higher odds of emergency room utilization compared to LDA (OR: 2.6, 95% CI: 1.3-4.9, P = 0.004). At two-years, patients undergoing ALIF demonstrated a higher risk of subsequent lumbar spine fusion (OR: 3.5, 95% CI: 1.8-6.5; P < 0.001) than patients undergoing LDA. At five-years, patients undergoing ALIF demonstrated higher rates of subsequent lumbar spine fusion (OR: 3.1, 95% CI: 1.7-5.6; P < 0.001). Rates of adjacent segment disease between LDA and ALIF were not significantly different at five years (OR: 1.4, 95% CI: 1.0-2.0; P = 0.088).
CONCLUSIONS: In young adult patients, LDA was associated with lower rates of lumbar spine reoperation when compared to single-level ALIF. These trends were observed despite similar rates of adjacent segment disease. Additional prospective studies are needed to explore additional reasons for reoperation including radiographic and patient satisfaction outcomes.
METHODS: A multi-institutional electronic health record database was queried for adult patients between 18 and 50 years of age undergoing single-level LDA or ALIF. Exclusion criteria were history of spine surgery, multiple level surgery, spine neoplasms, trauma, inflammatory, or infectious bone conditions. Comparisons were made with independent sample t-tests and odds ratios for complications were calculated at 30 days, two-years, and five-years.
RESULTS: Patients at a mean age of 41 ± 9 years (n = 1,156) were evenly divided into both cohorts. At thirty days, there were similar rates of medical complications between patients undergoing LDA and ALIF. Patients undergoing ALIF had higher odds of emergency room utilization compared to LDA (OR: 2.6, 95% CI: 1.3-4.9, P = 0.004). At two-years, patients undergoing ALIF demonstrated a higher risk of subsequent lumbar spine fusion (OR: 3.5, 95% CI: 1.8-6.5; P < 0.001) than patients undergoing LDA. At five-years, patients undergoing ALIF demonstrated higher rates of subsequent lumbar spine fusion (OR: 3.1, 95% CI: 1.7-5.6; P < 0.001). Rates of adjacent segment disease between LDA and ALIF were not significantly different at five years (OR: 1.4, 95% CI: 1.0-2.0; P = 0.088).
CONCLUSIONS: In young adult patients, LDA was associated with lower rates of lumbar spine reoperation when compared to single-level ALIF. These trends were observed despite similar rates of adjacent segment disease. Additional prospective studies are needed to explore additional reasons for reoperation including radiographic and patient satisfaction outcomes.