Rate of Reoperation Due to Adjacent Segment Disease Following Lumbar Interbody Fusion for Spinal Degeneration: A Systematic Review and Proportional Meta-Analysis

Introduction: Lumbar interbody fusion (LIF) treats spinal disorders like degeneration with approaches such as posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF), anterior lumbar interbody fusion (ALIF) and lateral lumbar interbody fusion (LLIF) offering distinct benefits. A key complication is adjacent segment disease (ASDis), often leading to pain and revision surgery. Owing to varying definitions of ASDis, reoperation rates are crucial for comparison. This study systematically reviews reoperation rates across LIF techniques.

Methods: A systematic review and meta-analysis followed PRISMA guidelines. The study protocol was registered with PROSPERO (CRD42024511845). A literature search was performed across Medline and Embase from inception to September 2023, focusing on studies reporting reoperations due to ASDis after LIF. Eligible studies included randomized controlled trials, cohort studies, and case series with follow-up periods of at least six months. Risk of bias was assessed using Joanna Briggs Institute, Newcastle-Ottawa, and Cochrane RoB tools. MetaXL software was utilized.

Results: The review identified 653 studies, with 34 included in the analysis. Meta-analysis revealed reoperation rates due to ASDis for different LIFs. ALIF (8 studies, n=1,514, 71.3 months follow-up) showed 7.3% overall (95% CI [5.9–9.1]), 3% < 5 years (95% CI [1–5], I²=0%), 11% >5 years (95% CI [2–24], I²=82%). PLIF (12 studies, n=3,821) had 6.1% overall (95% CI [3.9–8.5]), 8% < 5 years (95% CI [4–12], I²=88%), 9% >5 years (95% CI [7–10], I²=0%). LLIF (9 studies, n=932) revealed 4.6% overall (95% CI [2.9–6.7]), 4% < 5 years (95% CI [1–9], I²=82%), 9% >5 years (95% CI [5–15], one study). Open TLIF (4 studies) showed 8.5% overall (95% CI [5.1–12.7]), 4% < 5 years (95% CI [0–13], I²=65%), 22% >5 years (95% CI [0–60], I²=96%). MIS-TLIF (4 studies) had 2.8% overall (95% CI [1.5–4.6]), 2% < 5 years (95% CI [0–4], I²=65%), 7% >5 years (95% CI [0–22], I²=86%).

Conclusion : This meta-analysis demonstrates variability in ASDis reoperation rates across LIFs. Rates generally increase with longer follow-ups. Substantial heterogeneity and potential publication bias warrant careful interpretation. These findings highlight the importance of technique selection and ongoing long-term monitoring in managing ASDis risk.