Perioperative neurological deficits following anterior lumbar interbody fusion: Risk factors and clinical impact

Introduction: Anterior lumbar interbody fusion is a common and well-utilized approach to treatment of lower lumbosacral spondylolisthesis. The authors aim to assess the impact of perioperative neurological deficits on the in-hospital morbidity and mortality. As such, the clinical risk factors leading to perioperative neurological deficits in patients undergoing anterior lumbar interbody fusion are assessed in a large cohort sample from the national inpatient sample (NIS). Methods: Data was collected from the NIS-HCUP, a stratified sample of 20% of all community hospital discharges from the years 1999–2011 was analyzed. Patients who underwent anterior lumbar interbody fusion (ALIF) as their primary procedure were included. Results: The study cohort consisted of 67,900 patients with a mean age of 49.37 years. Approximately 54.96% of the patients were female, 83.60% were white, and 92.62% of the patients were operated on electively. The incidence of perioperative neurological deficit following ALIF was 1.02%. Perioperative neurological deficits were found to independently predict morbidity following ALIF in our multivariable analysis (OR 2.07; CI 1.688 – 2.541) but were not an independent predictor of mortality. Patients with increasing age (OR 1.034; CI 1.027–1.041) and high vWR 5–14 (OR 1.456; CI 1.065–1.990) had an increased risk of having perioperative neurological deficits. Conclusion: Overall, perioperative neurological deficits following ALIF are rare (1.02%), and mortality is extraordinarily rare (0.15%). Patients with older age and higher comorbidities are at increased risk for of perioperative neurological deficit and consequently in hospital morbidity. As such, these results serve to further illuminate the importance of preoperative screening and proper patient stratification.