OBJECTIVES

: Patients may undergo anterior lumbar interbody fusion (ALIF) for treatment of degenerative disc disease, which can include the use of standalone cage devices to promote fusion across the disk space. During ALIFs with standalone devices, the surgeon may choose to additionally perform posterior fixation. To understand surgeon preferences during ALIF procedures, this study compared the rate of patients receiving fixation concurrent with ALIF of standalone cages.

METHODS

: Patients who underwent ALIF of 2-3 vertebrae were identified in the Premier Healthcare Database using ICD-9/10 codes, 2010-2016. The cohort was categorized by cage: SYNFIX® LR System (DePuy Synthes, Raynham, MA) versus a group of comparator cages (non-SYNFIX). Patient, provider, hospital characteristics were collected. Patient outcomes evaluated were percent of fixation concurrent with ALIF, hospital costs, and operation room time (ORT). Logistic regression and generalized estimating equations were used to adjust outcomes.

RESULTS

: Of the 2,238 patients identified, 51.2% received SYNFIX® LR. Patients with SYNFIX® LR were younger (mean (SD), 47.9 (13.1) vs. 50.6 (12.1)), and more often male 47.1% vs. 43.7%; rates of diabetes (10.4% vs. 11.5%) and hypertension (37.3% vs. 42.0%), SYNFIX® LR vs. non-SYNFIX, were comparable. Procedures with SYNFIX® LR occurred more often at teaching hospitals (50.0% vs. 20.2%), but a similar frequency in urban hospitals (89.2% vs. 95.0%). SYNFIX® LR had a statistically significant lower odds of fixation, odds ratio, 0.75 (95% Confidence Interval (CI) 0.567, 0.996; p-value = 0.047). Overall procedure costs and ORT differences were not statistically significant, but mean values were lower for SYNFIX® LR: $31,839 (95% CI: $28,999-$34,957) vs. $33,694 ($30,565-$37,143); ORT 165.7 (157.9-173.9) vs. 176.6 (168.8-184.9) minutes.

CONCLUSIONS

: In patients treated with SYNFIX® LR vs. Non-SYNFIX, there was a statistically significant 25% reduction in fixation at the time of ALIF, with lower trends of overall procedure costs and ORT that were not statistically significant.