Optimizing Lumbar Fusion: An Analysis of Surgical Approaches in the Elderly

Introduction: Lumbar Interbody Fusion (LIF) is a surgical procedure that involves fusing two adjacent spinal vertebrae to immobilize a joint in the vertebral column. Increasing numbers of older adults are undergoing LIF surgery, with anterior approach (AF) or a combined anterior and posterior approach (A/P) being the most prevalent. Our study compared complication rates in elderly patients undergoing AF versus A/P LIF surgery.

Methods: The 2015(Q4)-2019 National Inpatient Sample Database was queried using ICD-10-PCS procedure codes to identify all patients who received LIF, stratified by AF and A/P approaches. Complications were analyzed by procedure approach and age group ( < 65, 65-79, 80+ years). A multivariate logistic regression analysis was performed to determine the risk of surgical complications between cohorts, and odds ratios were adjusted for sex, race, and socioeconomic status.

Results: Of 148,864 patients undergoing lumbar fusion surgery, 48,944 patients were included in the study, with exclusion of 99,920 patients that underwent posterior approach-only with no interbody fusion. From the included patients, 31,133 were < 65 years old (63.61%), 16,473 patients were between ages 65-79 (33.66%), and 1,338 patients were age 80+ (2.73%). The risk of experiencing at least one complication irrespective of procedure approach was highest in the 80+ age cohort (OR 2.12, p< 0.001), compared to the 65-79 year age cohort (OR 1.74, p= < 0.001) and < 65 reference group. Within the 65-79 group, patients who underwent A/P exhibited a statistically significant increase in at least one complication (OR 1.21, p=0.032).

Conclusion : Our findings suggest that patients of increasing age are at significantly greater risk of experiencing surgical complications associated with LIF. When comparing AF and A/P approaches, the A/P approach demonstrated increased complication risk in the 65-79 cohort only.