Impact of Hyperlipidemia and Lipid-Lowering Agents on Pseudarthrosis Rates After Single-Level and Multilevel Anterior Lumbar Interbody Fusion

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STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To investigate how preoperative low-density lipoprotein (LDL) levels and intake of statin, fish oil, or ezetimibe affect rates of pseudarthrosis after single-level and multilevel anterior lumbar interbody fusion (ALIF). SUMMARY OF BACKGROUND DATA: ALIF may be performed to treat degenerative disc disease, spondylolisthesis, spinal instability, and deformity. Pseudarthrosis is a concern following ALIF due to the high axial load and segmental motion of the lumbar spine. Hyperlipidemia can affect fusion rates by limiting blood flow to the surgical site and stimulating systemic inflammation. No studies have explored the association between preoperative LDL levels and statin, fish oil, or ezetimibe intake on pseudarthrosis in ALIF. METHODS: TriNetX was used to query patients undergoing ALIF. Pseudarthrosis rates at 6 months, 1 year, and 2 years following single-level and multilevel ALIF were compared between patients with high (≥140 mg/dL) and low LDL (≤66 mg/dL). Patients were also compared based on intake of fish oil, statin, or ezetimibe. Cohorts underwent 1:1 propensity score matching to limit confounding. RESULTS: Patients with low LDL and those taking a statin had lower rates of pseudarthrosis at all time points within 2 years after multilevel ALIF but not single-level ALIF. Preoperative statin intake was associated with lower LDL levels after single- and multilevel ALIF. Fish oil and ezetimibe were not associated with risk of pseudarthrosis. CONCLUSION: Preoperative LDL levels and intake of a statin may modulate risk of pseudarthrosis after multilevel ALIF. Given the relatively low-risk profile of statins and modifiable nature of LDL levels, these findings highlight potentially important areas for multidisciplinary patient optimization and risk stratification. LEVEL OF EVIDENCE: Level IV.

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