Risks, Cost of ALIF Questioned
With questionable long-term outcomes and cost issues, anterior lumbar interbody fusions (ALIF) may not be as good as posterior or transforaminal (P/TLIF), says new research. The study, “A Comparison of Anterior and Posterior Lumbar Interbody Fusions: Complications, Readmissions, Discharge Dispositions, and Costs,” appears in the December 15, 2017 edition of Spine.
Hamid Hassanzadeh, M.D., a co-author on the study and a member of the Department of Orthopaedic Surgery at the University of Virginia in Charlottesville, tells OTW, “Lumbar interbody fusions are common in the practice of spine surgery, and there are a variety of techniques available for performing them.”
“As surgeons, it falls on us to choose the best approach for each of our patients. In order to make the most informed decision, we need to know how the outcomes of each approach differ.”
The authors wrote, “PearlDiver Database of Medicare records was utilized for this retrospective database review. A study group consisting solely of ALIF procedure patients was selected. Similarly, a TLIF/PLIF group was selected for. Both groups were queried for comorbidities, 30- and 90-day complication and readmission rates. Additionally, discharge dispositions, and in-hospital/30-day/90-day Medicare reimbursements were determined.”
Dr. Hassanzadeh commented to OTW, “We found that patients undergoing ALIF face increased odds of ileus, wound infection, and lower extremity DVT [deep vein thrombosis] compared to patients undergoing PLIF/TLIF. However, the odds of transfusion and dural tear are significantly lower with the ALIF procedure. ALIF is also associated with greater overall cost and risk of admission.”
“The best lumbar interbody fusion approach is something that needs to be determined for each patient on a case-by-case basis. Every patient’s pathology and history is different. A patient with anterior translational instability or anterior disc slippage may benefit greatly from the anterior approach. However, the additional risk of complications and cost associated with ALIF may not be justified in patients with more posteriorly located pathology.”
