The Influence of Common Medical Conditions on the Outcome of Anterior Lumbar Interbody Fusion

Study Design:The authors retrospectively reviewed a consecutive series of 231 patients with anterior lumbar interbody fusion (ALIF).Objective:To determine the correlations among common medical conditions, demographics, and the natural history of lumbar surgery with outcomes of ALIF.Summary of Background Data:Multiple spinal disorders are treated with ALIF with excellent success rates. Nonetheless, adverse outcomes and complications related to patients' overall demographics, comorbidities, or cigarette smoking have been reported.Methods:The age, sex, body mass index (BMI), comorbidities, history of smoking or previous lumbar surgery, operative parameters, and complications of 231 patients who underwent ALIF were analyzed. Regression analyses of all variables with complications and surgical outcomes based on total Prolo scores were performed. Two models predicting Prolo outcome score were generated. The first model used BMI and sex interaction, whereas the second model used sex, level of surgery, presence of diabetes mellitus, and BMI as variables.Results:At follow-up, the rate of successful fusion was 99%. The overall complication rate was 13.8%, 1.8% of which occurred intraoperatively and 12% during follow-up. The incidence of complications failed to correlate with demographics, comorbidities, smoking, or previous lumbar surgery (P>0.5). ALIF at T12-L4 was the only factor significantly associated with poor patient outcomes (P=0.024). Both models successfully predicted outcome (P=0.05), although the second model did so only for males.Conclusions:Surgical level of ALIF correlated with poor patient outcomes as measured by Prolo functional scale. BMI emerged as a significant predictor of Prolo total score. Both multivariate models also successfully predicted outcomes. Surgical or follow-up complications were not associated with patients' preoperative status.