RESUMEN
STUDY DESIGN: Retrospective comparative study. OBJECTIVE: This study compared outcomes for patients managed with a lateral approach to interbody fusion [lateral (LLIF) or oblique (OLIF)] versus a posterior (PLIF) or transforaminal interbody fusion (TLIF) for treatment of adjacent segment disease (ASD) above or below a prior lumbar fusion construct. SUMMARY OF BACKGROUND DATA: No study has compared outcomes of lateral approaches to more traditional posterior approaches for the treatment of ASD. METHODS: Retrospective review was performed of patients who underwent single-level lateral or posterior approaches for lumbar interbody fusion for symptomatic ASD between January 2010 and December 2021. Exclusion criteria included skeletal immaturity (age below 18 y old) and surgery indication for malignancy or infection. Patient demographics, medical comorbidities, operative details, postoperative complications, and revision surgery profiles were collected for all patients. Standard descriptive statistics were used to summarize data. Comparative statistical analyses were performed using Statistical Package for the Social Sciences (Version 28.0.1.0; Chicago, IL). RESULTS: A total of 152 patients (65±10 y) were included in the study with a mean duration of follow-up of 1.6±1.4 years. The cohort included 123 PLIF/TLIF (81%), 18 LLIF (12%), 11 OLIF (7%). TLIF/PLIF experienced greater mean operative time (210±62 min vs. 184±80 OLIF/105±64 LLIF, P<0.001) and estimated blood loss (414±254 mL vs. 49±29 OLIF/36±33 LLIF, P<0.001). No significant difference in rate of postoperative complications. Postoperative radicular pain was significantly greater in OLIF (7, 64%) and LLIF (7, 39%) compared with PLIF/TLIF (16, 13%), P<0.001. No statistically significant difference in health care utilization was noted between the groups. CONCLUSION: Lateral fusions to treat ASD demonstrated no significantly different risk of complication compared with posterior approaches. Our study demonstrated significantly increased operative time and estimated blood loss for the posterior approach and an increased risk of radicular pain from manipulation/retraction of psoas following lateral approaches. LEVEL OF EVIDENCE: Level III.
RESUMEN
BACKGROUND: This investigation sought to quantify incidence rates (IRs) and risk factors for primary and secondary (ie, posttraumatic) osteoarthritis (OA) of the knee in an active military population. METHODS: We performed a retrospective review of United States military active duty servicemembers with first-time diagnosis of primary (International Classification of Disease, 9th Edition code: 715.16) and secondary (International Classification of Disease, 9th Edition code: 715.26) OA of the knee between 2005 and 2014 using the Defense Medical Epidemiology Database. IRs and 95% CIs were expressed per 1000 person-years, with stratified subgroup analysis adjusted for sex, age, race, military rank, and branch of military service. Relative risk factors were evaluated using IR ratios and multiple regression analysis. RESULTS: A total of 21,318 cases of OA of the knee were identified among an at-risk population of 13,820,906 person-years for an overall IR of 1.54 per 1000 person-years, including 19,504 cases of primary (IR: 1.41) and 1814 cases of secondary OA (IR: 0.13). The IRs of both primary and secondary OA increased significantly from 2005 to 2014. Increasing age (P < .0001); black race (P < .001); senior military rank (P < .0001); and Army, Marines, and Air Force services (P < .0001) were significantly associated with an increased risk for knee OA. CONCLUSION: This study is the first large-scale report of knee OA in a young athletic population. An increasing incidence and several risk factors for knee OA were identified, indicating a need for better preventative strategies and forecasting the increased anticipated demands for knee arthroplasty among US military servicemembers.