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Few studies have focused on outcomes among Workers' Compensation (WC) claimants undergoing anterior lumbar interbody fusion (ALIF). To determine the influence of WC on perioperative outcomes, patient-reported outcome measures (PROMs) and attainment rates of minimal clinically important difference (MCID) among patients undergoing single-level ALIF at L5S1. Retrospective. A retrospective surgical database of an attending spine surgeon was utilized to identify patients with WC insurance undergoing single-level ALIF at L5S1. One-hundred and nine patients were included, with 82 in the non-WC and 27 in the WC cohort. PROM data for visual analog scale (VAS) back/leg, Oswestry Disability Index (ODI), 12-Item Short Form (SF-12) Physical Composite Score (PCS) and Patient Reported Outcome Measurement Information System physical function (PROMIS-PF) was obtained preoperatively and at 6-weeks, 12-weeks, 6-months, 1-year and 2-years following ALIF. Patients were divided into groups based on insurance status: WC vs non-WC (including patients with private insurance or Medicare/Medicaid). Demographic and perioperative information was evaluated between insurance groups using student's t-test for independent samples for continuous variables and chi-squared test for categorical variables. Mean PROMs were compared with student's t-test for independent samples. Comparisons of preoperative and postoperative PROM values were evaluated with paired sample t-tests. Patients who achieved an improvement in PROM score greater than or equal to established threshold values were marked as achieving MCID. WC and non-WC groups were compared in MCID attainment rates across PROMs with chi-squared analyses. A greater proportion of the non-WC cohort were Caucasian, while a significantly greater proportion of the WC cohort were African American and Hispanic (p=0.001). Significantly more patients in the WC cohort were smokers (p<0.001). Non-WC patients improved significantly from preoperative to postoperative timepoints of 6-months through 2-years for PROMIS-PF and SF-12 PCS, 6 weeks through 1 year for VAS back, 6 months/1 year for VAS leg and 12 weeks through 1-year for ODI (p≤0.048, all). WC patients improved significantly at postoperative timepoints for PROMIS-PF at 6 weeks (p=0.029), SF-12 PCS at 12 weeks (p=0.018), VAS back from 6 weeks to 6 months, and VAS leg at 6 months, only (p≤0.029, all). Mean VAS back scores were significantly greater in the WC cohort at 6 months and 1 year (p≤0.013, both), mean VAS leg scores were significantly greater in the WC cohort at 1 year (p=0.029), and mean ODI scores were significantly higher in the WC cohort at preoperative through 1 year (p≤0.040, all). With the exception of higher MCID achievement for VAS back at 12 weeks (p=0.037), no other differences in attainment rates were observed for any PROM at any time point or for the overall postoperative period. Among patients receiving ALIF, WC insurance was more prevalent among patients identifying as Hispanic and African American, along with smokers. While physical function scores were similar between groups, long-term pain and disability (throughout the entire postoperative period) were significantly higher among patients with WC. MCID achievement, however, was largely comparable for all PROMs between WC and non-WC study groups. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

Lumbar fusion procedures are at risk for pseudarthrosis as a complication. Despite its relative prevalence, few studies have characterized the clinical efficacy of salvage procedures. To characterize clinical outcomes following anterior lumbar interbody fusion (ALIF) as a salvage procedure for pseudarthrosis of transforaminal lumbar interbody fusion (TLIF). Retrospective. Thirty-four ALIF patients. VAS back and leg, ODI, SF-12 PCS, VR-12 PCS. A retrospective review of a surgical database of eligible procedures between November 2010 and June 2020 was performed. Inclusion criteria were as follows: single-level revision ALIF procedures performed at the index level for pseudarthrosis of TLIF. Patients were excluded if procedures were primary or performed for infectious, malignant or traumatic etiologies. Demographic and perioperative characteristics were collected. Additionally, time to revision, rates of 1-year arthrodesis, 6-month pseudarthrosis and postoperative complications were calculated. Radiographic measurements were performed to evaluate sagittal alignment and disc height at the preoperative, immediate postoperative and final postoperative timepoint. Differences between preoperative and final postoperative radiographic measurements were evaluated using a Student's t-test. Visual analog scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), 12-Item Short Form physical composite score (SF-12 PCS and VR-12 PCS) were collected preoperatively and postoperatively. Overall achievement of a minimum clinically important difference (MCID) was calculated using the following established values: 1.2 (VAS Back), 1.6 (VAS leg), 12.8 (ODI), 4.0 (SF-12 PCS). A total of 34 patients who underwent an ALIF revision procedure at the index level were identified. Mean age was 46.7 years with 81.1% being male and 64.9% obese (body mass index: 30 kg/m2). A total of 83.8% had an ASA < 2 and 75.5% carried a CCI > 1. Mean time from index TLIF to salvage ALIF procedure was 21.3 months. Mean operative time was 135.3 minutes with an average blood loss of 75.0mL and hospital length of stay of 49.5 hours. The majority of procedures were performed at the L5-S1 level (73.5%). Patients demonstrated a one-year arthrodesis rate of 100.0% with 2/34 patients requiring an additional revision procedure at the index level for neuroforaminal bone growth. A total of six postoperative complications were observed with one patient suffering from a mild urinary tract infection, one with acute renal failure, one with a venous thromboembolism, one with altered mental status, and two with fever of unknown origin. Following ALIF salvage, there was a significant increase in segmental lordosis, mean anterior and posterior disc height, as well as average disc height (p≤0.037, all). Mean preoperative outcome scores were 7.2 ± 1.9 for VAS back, 6.8 ± 2.8 for VAS leg, 56.7 ± 16.5 for ODI, and 28.1 ± 10.9 for SF-12 PCS. Clinically relevant improvement of PROMs as measured by MCID achievement rates by one-year were 67.1% for VAS back, 57.1% for VAS leg, 40.0% for ODI and 37.5% for SF-12 PCS. Use of ALIF as a salvage procedure at either the L4-5 or L5-S1 level for TLIF pseudoarthrosis demonstrated a high arthrodesis rate at one-year. Patients demonstrated high rates of MCID achievement for back and leg pain, as well as ODI. These results support the use of ALIF as a salvage procedure for failed TLIFs at the L4-5 and L5-S1 levels. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

Achieving arthrodesis after spinal tumor surgery remains a significant challenge. Patients in this vulnerable cohort commonly experience poor bone quality, malnutrition and concurrent use of chemotherapy or radiotherapy—all of which interfere with proper bone formation and healing. To augment fusion efforts, recombinant human bone morphogenetic protein-2 (rhBMP-2) emerged as a powerful osteogenic factor after its FDA approval in 2002 but its use has remained a persistent concern. Although most recent evidence does not seem to suggest significantly increased rates of complications or carcinogenicity due to rhBMP-2 use, these findings remain poorly defined in the spinal oncology subcohort. To investigate national rates of rhBMP-2 utilization in spinal tumor surgery and examine its association with postoperative complications, revisions, and carcinogenicity. Retrospective national database analysis. All patients diagnosed with primary or metastatic spinal tumors who underwent subsequent surgical intervention involving a spinal fusion recorded in Medicare, Medicaid, and commercial administrate claims databases in PearlDiver from 2005-2020. Utilization rates; postoperative rates of complications, revisions, and failures; survivorship. Patients were organized into two cohorts according to rhBMP-2 usage and 1:1 matched based on age, gender, and Charlson Comorbidity Index. rhBMP-2 utilization trends were compared via a Pearson correlation across calendar years. Postoperative complications and revisions were examined at 1 month, 3 months, 6 months, and 1 year after spinal fusion. New cancer incidence following spinal tumor surgery was assessed until 5 years postoperatively. Post hoc comparisons were characterized using chi-squared analysis, and threshold for significance was established at P < 0.05. A total of 11,198 patients underwent fusion surgery after resection of spinal tumors between 2005 and 2020, with 909 cases reporting the use of rhBMP-2 (8.1%). An annualized analysis revealed that the proportion of spine tumor fusion procedures utilizing rhBMP-2 has been significantly decreasing (R2 = 0.859, P < 0.001), with the most recent annual utilization rate at 1.1%. The final matched cohorts each comprised 894 patients. At least 6 months after surgery, significantly increased incidences of surgical site (7.3% vs 1.6%, P = 0.05) and systemic infections (13.8% vs 4.1%, P = 0.01) were observed in patients who underwent fusion with rhBMP-2. Across all time points, no significant differences were observed between the groups in survival, implant removal, or revision rates. In addition, incidence of new cancer diagnoses after fusion surgery was comparable between the two groups. rhBMP-2 has been widely used off-label to promote arthrodesis; however. its role in spinal fusion procedures involving spinal tumors remains controversial. This analysis demonstrated significantly declining national utilization rates, and while rhBMP-2 usage was not associated with new cancer incidence postoperatively, its impact on local and metastatic progression remains unknown and requires further investigation. Compared with nonusers, spinal tumor cases utilizing rhBMP-2 sustained greater rates of surgical site and systemic infections. Furthermore, rhBMP-2 usage did not significantly reduce the risk of mortality, implant failure, or reoperation–suggesting it may not be essential to fulfilling the needs of this specific patient population. BMP-2: not approved for this indication. [ABSTRACT FROM AUTHOR]