Describing the Safety Profile and Outcomes Across Different Lumbar Interbody Fusion Techniques in Nearly 4000 Patients from the Michigan Spine Surgery Improvement Collaborative (MSSIC)

Introduction: There is a paucity of literature providing a comprehensive description of safety and immediate postoperative outcomes across different lumbar interbody fusion techniques. We sought to characterize and compare the safety profiles of anterior lumbar interbody fusions (ALIF), Transforaminal Lumbar Interbody Fusion (TLIF), Posterior Lumbar Interbody Fusion (PLIF), and Lateral Lumbar Interbody Fusion (LLIF).

Methods: Using data from the MSSIC database, we retrospectively reviewed cases from 3,796 patients who underwent a single-level lumbar interbody fusion via ALIF, TLIF, PLIF, or LLIF from 2017-2022. Patient demographic information was collected as well as medical comorbidities (i.e. osteoporosis, hypertension, diabetes, and prior spine surgery). Various perioperative outcomes (i.e. operative time) and complications (i.e. durotomy, UTI, and SSI) were collected with rates compared among the different fusion techniques. Additional outcomes were also collected including length of stay, disposition location, and readmission rates.

Results: Of the total 3,796 patients, there was an average age of 58.6 years (+/- 12.9) with 2,233 (58.8%) females. Patients underwent one of the following fusion techniques: ALIF (n=536), PLIF (n=566), TLIF (n=2527), and LLIF (n=167). Average age (p < 0.001), BMI (p=0.003), and medical history (p < 0.001differed significantly among the fusion techniques with patients in the ALIF group being younger and less likely to present with notable comorbidities.

Significant differences in surgical characteristics and outcomes were found in operative time (p < 0.001), blood loss (p < 0.001), durotomy (p=0.002), CSF leak (p=0.02), LOS (p < 0.001), disposition location (p < 0.001), post-op axial pain (p < 0.001), and post-op urinary retention (p < 0.001). While LLIF had the highest average operative time (156 +/- 69 minutes), PLIF had the highest blood loos (153 +/- 163cc). ALIF and LLIF had lower instances of intraoperative complications such as durotomy (3 and 1, respectively) and postoperative complications like urinary retention (13 and 1, respectively).

Conclusion : While lumbar interbody fusion is a well-defined and safe surgical technique, we comprehensively describe the varying safety profiles of different interbody fusion techniques to help inform surgical decision making.