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Different Fusion Approaches for Single-level Lumbar Spondylolysis Have Similar Perioperative Outcomes

Gala, Raj, J., MD*; Bovonratwet, Patawut, BS*; Webb, Matthew, L., MD; Varthi, Arya, G., MD; Daubs, Michael, D., MD§; Grauer, Jonathan, N., MD*

doi: 10.1097/BRS.0000000000002262

Study Design. Retrospective cohort study

Objective. The aim of this study was to compare perioperative adverse events for patients with lumbar spondylolysis treated with transforaminal lumbar interbody fusion (TLIF), posterior spinal fusion (PSF), combined anterior and posterior fusion (AP fusion), or anterior lumbar interbody fusion (ALIF).

Summary of Background Data. Previous cohort studies have shown similar long-term outcomes for different surgical approaches for this indication, but potential differences in 30-day perioperative adverse events have not been well characterized.

Methods. The present study uses data extracted from the American College of Surgeons National Surgical Quality Improvement Database. Patients undergoing fusion with different approaches for lumbar spondylolysis were identified. Propensity score matching was utilized to account for potential differences in demographic and comorbidity factors. Comparisons among perioperative outcomes were then made among the propensity score-matched study groups.

Results. Of 1077 cases of spondylolysis identified, 556 underwent TLIF, 327 underwent PSF, 108 underwent AP fusion, and 86 underwent ALIF. After propensity score matching, there were no differences in the rates of any of the 30-day individual adverse events studied and no differences in the aggregated groupings of any adverse event, serious adverse event, or minor adverse event. There was a significantly increased operative time in the AP fusion group, but there were no differences in hospital length of stay or readmission rates.

Conclusion. Because perioperative adverse event rates were similar, even with a slightly longer operative time in the AP fusion group, these findings suggest that surgeon preference and long-term outcomes are better used to determine the recommendation of one surgical approach over another for single level fusions for lumbar spondylolysis.

Level of Evidence. 3

*Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT

Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA

Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL

§Division of Orthopaedic Surgery, University of Nevada School of Medicine, Las Vegas, NV.

Address correspondence and reprint requests to Jonathan N. Grauer, MD, Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College St, New Haven, CT 06510; E-mail:

Received 7 March, 2017

Revised 12 April, 2017

Accepted 19 April, 2017

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, grants, expert testimony.

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