Study design:

Retrospective Cohort.

Objective:

To (1) compare the rates of fusion techniques over the last decade; (2) identify if surgeon experience affects a surgeon’s preferred fusion technique; (3) evaluate differences in complications, readmissions, mortality, and patient reported outcomes measures (PROMs) based on fusion technique.

Summary of background data:

Database studies indicate the number of lumbar fusions have been steadily increasing over the last two decades; however, insufficient granularity exists to detect if surgeons’ preferences are altered based on additive surgical experience.

Methods:

A retrospective review of continuously collected patients undergoing lumbar fusion at a single urban academic center was performed. Rates of lumbar fusion technique: posterolateral fusion (PLDF), transforaminal lumbar interbody fusion (TLIF), anterior lumbar interbody fusion + PLDF (ALIF), and lateral lumbar interbody fusion + PLDF (LLIF)) were recorded. Inpatient complications, 90-day readmission, and inpatient mortality were compared with χ 2 test and Bonferroni correction. The Δ 1-year PROMs were compared with analysis of variance (ANOVA).

Results:

Of 3,938 lumbar fusions, 1,647 (41.8%) were PLDFs, 1,356 (34.4%) were TLIFs, 885 (21.7%) were ALIFs, and 80 (2.0%) were LLIFs. Lumbar fusion rates increased but interbody fusion rates (2012: 57.3%; 2019: 57.6%) were stable across the study period. Surgeons with <10 years of experience performed more PLDFs and less ALIFs, while surgeons with >10 years’ experience used ALIFs, TLIFs, and PLDFs at similar rates. Patients were more likely to be discharged home over course of the decade (2012: 78.4%; 2019: 83.8%, P<0.001). No differences were observed between the techniques in regard to inpatient mortality (P=0.441) or Δ (postoperative minus preoperative) PROMs.

Conclusion:

Preferred lumbar fusion technique varies by surgeon preference, but typically remains stable over the course of a decade. The preferred fusion technique did not correlate with differences in PROMs, inpatient mortality, patient complication rates.

Levels of evidence:

3 (treatment).