ALIF Versus P/TLIF for Lumbar Spondylolisthesis: National Outcomes on Complications, Disposition, Mortality, and Cost From 2016 to 2022

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Study Design Retrospective Cohort Study. Objectives There are several approaches for lumbar fusion, which is often used to treat degenerative lumbar spondylolisthesis. This study aimed to compare perioperative complications, mortality, discharge disposition, and costs amongst patients undergoing anterior (ALIF) and posterior/transforaminal lumbar interbody fusion (P/TLIF). Methods The National Inpatient Sample was queried from 2016-2022 for admissions after ALIF, PLIF, or TLIF in the setting of degenerative lumbar spondylolisthesis. Perioperative complications, discharge disposition, and mortality rates were compared using survey-weighted regression models. Cost and length of stay (LOS) were compared using survey-weighted means and t-tests. Significance was set at P < 0.05. Results 70,580 weighted elective inpatient admissions (ALIF - 12,410, P/TLIF - 58,170) were included. P/TLIF patients were older (63.6 vs 62.3 years, P < 0.001) and more frequently underwent single-level fusions (83.0% vs 78.1%, P < 0.001). P/TLIF had higher odds of CSF leak/dural tear (OR 2.34, 95% CI 1.43-3.83, P < 0.001), transfusion (OR 1.42, 95% CI 1.03-1.97, P = 0.032), adverse events (OR 1.18, 95% CI 1.02-1.37, P = 0.028), and non-routine discharge (OR 1.17, 95% CI 1.05-1.30, P = 0.005). P/TLIF had lower odds of vascular injury (OR 0.03, 95% CI 0.00-0.33, P = 0.003) and lower inpatient mortality (OR 0.13, 95% CI 0.04-0.45, P = 0.001). ALIF incurred higher costs ($43,003 vs $35,513, P < 0.001). LOS was shorter with ALIF (2.81 vs 3.03 days, P < 0.001). Conclusion The P/TLIF and ALIF cohorts were associated with unique perioperative risk profiles. ALIF was associated with decreased LOS but increased costs. These findings can be used to guide operative management in patients with degenerative spondylolisthesis. Level of Evidence III.

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