Study design:

Retrospective chart review.

Objective:

This study aimed to examine postoperative radiculitis after isolated L5-S1 ALIF, determine which factors contribute to its development, and investigate the comparative outcomes of patients with vs. without postoperative radiculitis.

Summary of background data:

Both stand-alone and traditional anterior lumbar interbody fusion (ALIF) are common and safe lumbar spine fusion techniques. Although optimal safety and effectiveness are achieved through appropriate patient selection, postoperative radiculitis after L5-S1 ALIF is a potential complication that appears to be the least predictable in the absence of iatrogenic injury.

Methods:

All adult patients (18-80 y) with preoperative radiculopathies who underwent L5-S1 ALIF by nine board-certified spine surgeons at a single academic institution from January 2016 to December 2021 with a minimum of 3-months follow-up were included. Patient records were assessed for data on clinical characteristics and patient-reported outcome scores (PROMs). All patient records were evaluated to determine whether postoperative radiculitis developed. Radiographic measurements using X-rays were completed using all available pre-& post-operative imaging. Multivariable logistic regressions were performed utilizing radiculitis as the dependent variable and various independent predictor variables.

Results:

140 patients were included, 48 (34%) patients developed postoperative radiculitis, with symptom onset and resolution occurring at 14.5 and 83 days, respectively. The two groups had no differences in preoperative or postoperative radiographic parameters. Multivariable regression showed three independent predictors of postoperative radiculitis: methylprednisolone use [OR: 6.032; (95% CI: 1.670-25.568)], increased implant height [OR: 1.509; (95% CI: 1.189-1.960)], and no posterior fixation [OR: 2.973; (95% CI: 1.353-.806)].

Conclusion:

Of the 34% of patients who developed postoperative radiculitis following L5-S1 ALIF, it resolved on average within 3 months of surgery. These findings may help reduce the risk of undue short-term morbidity following isolated L5-S1 ALIF by informing preoperative counseling and intraoperative decision-making.