INTRODUCTION: Surgical management for isthmic spondylolisthesis (IS) can be accomplished with either an anterior, posterior, or combined approach. This study compares 90-day medical and surgical complications of anterior, posterior, and combined lumbar fusion for adults with single-level IS. METHODS: Deidentified patient data were obtained through the PearlDiver database using relevant ICD and current procedural terminology codes from 2015 to 2022. Patients ≥18 years with single-level IS who had undergone either anterior lumbar fusion (ALIF), posterior lumbar fusion (PLF), or combined AP lumbar fusion (CLF) were evaluated. Patients undergoing more than one level lumbar fusion were excluded, and 90-day postoperative complications were compared across cohorts. RESULTS: Of 43,619 patients who underwent surgery for IS, 4,622 (10.6%) had ALF, 35,550 (81.5%) PLF, and 3,447 (7.90%) CLF. At 90 days postoperatively, multivariate analysis controlling for demographics, tobacco use, and obesity reveals that odds of readmission were significantly lower in patients who underwent PLF (odds ratio OR 0.81, P 0.05). CONCLUSION: Among adult patients with IS undergoing single-level lumbar fusion, 81.5% had posterior surgery while 7.9% had combined AP surgery. Compared with the anterior approach, patients undergoing the posterior approach had lower 90-day readmission rates and postoperative ileus rates. However, patients undergoing posterior or combined surgery had higher odds of requiring revision surgery within 90 days. These differences in complication profile may help surgeons in surgical decision making on which approach to consider in their patients with IS.
Frei et al. (Fri,) studied this question.