Revision surgery rates following transforaminal lumbar interbody fusion in patients with and without osteoporosis.

Abstract

Background context: Osteoporosis is becoming increasingly prevalent in the spine surgery population and has been shown to be associated with surgical failure in spinal deformity operations. Little is known about the impact of osteoporosis on radiographic and surgical complications following degenerative fusion techniques.

Purpose: To compare complications and radiographic alignment in osteoporotic versus nonosteoporotic patients undergoing transforaminal lumbar interbody fusion (TLIF).

Design: Retrospective cohort study.

Patient sample: A total of 78 patients, 39 with osteoporosis and 39 without osteoporosis, were included in this study.

Outcome measures: The following data were observed for all cases: patient demographics, radiographic alignment, and complications.

Methods: Adult patients with 2-year follow-up who underwent transforaminal lumbar interbody fusion (TLIF) at a single academic institution were identified. Eligible patients were propensity matched by the presence of osteoporosis while accounting for age, sex, and BMI. Patient demographics, procedural characteristics, preoperative to 2-year postoperative change in spinopelvic alignment, and complications were compared. Multivariate regression analyses, accounting for age, gender, and Charlson Comorbidity Index (CCI), were performed to evaluate outcomes following TLIF.

Results: In total, 78 patients with complete data were included with a mean age of 63.28, 70.51% were female, mean CCI was 1.02 and mean clinical follow up was 33.3 months. At 2 years postoperatively, osteoporosis patients had a significantly greater increase in PI-LL from preoperation (6.55° vs. -0.02°, p=.010). In addition, while there was no statistically significant difference in medical and surgical complication (all p>.05), osteoporosis patients were 2.8 times more likely to develop adjacent segment disease (p=.05). Additionally, over 30% of patients with osteoporosis underwent revision and osteoporotic patients were 9.2 times more likely to undergo revision (p=.008) than patients without osteoporosis, most commonly for adjacent segment disease.

Conclusion: In this single-center multisurgeon study, osteoporotic patients experienced significant worsening of PI-LL mismatch postoperatively and had a higher incidence of adjacent segment disease and revision. Although TLIF remains an important procedure in osteoporotic patients, increased care should be taken to optimize bone quality in the perioperative period to avoid potential mechanical and surgical complications.