136 - Postoperative Radiculitis in Patients with Preoperative Radicular Symptoms Following Single-Level Anterior Lumbar Interbody Fusion

Saturday, June 3, 2023

11:50 AM – 11:52 AM

Location: Salons 13-15

Co-Author(s)

KA

Kasra Araghi, BS

Research Fellow
Hospital for Special Surgery
Scottsdale, Arizona, United States
MF

Mitchell S. Fourman, MD M.Phil

Asst Professor of Orthopaedic Surgery
Montefiore Einstein
Harrison, New York, United States
RM

Robert Merrill, MD

Hospital for Special Surgery, United States
OM

Omri Maayan, BS

Hospital for Special Surgery, United States
EZ

Eric Zhao, BS

Hospital for Special Surgery, United States

Presenting Author (Person doing the Podium Present(s)

AP

Anthony Pajak, BS

Hospital for Special Surgery, United States

Co-Author(s)

DK

David Kim, BS

Hospital for Special Surgery, United States
TS

Tejas Subramanian, BS

Hospital for Special Surgery, United States
Robert Kamil, BS

Medical Student Research Fellow
Hospital for Special Surgery, United States
PS

Pratyush Shahi, MBBS

Hospital for Special Surgery
New York, New York, United States
JD

Jerry Du, MD

Hospital for Special Surgery, United States
JC

John Clohisy, MD

Hospital for Special Surgery, United States
BZ

Bo Zhang, MD

United States
ES

Evan Sheha, MD

Hospital for Special Surgery, United States
JD

James E. Dowdell, MD

Spine Fellow
Hospital for Special Surgery
New York, New York, United States
SI

Sravisht Iyer, MD

Assistant Attending, Spine Surgery
Hospital for Special Surgery
New York, New York, United States
SQ

Sheeraz A. Qureshi, MD, MBA

Attending Surgeon
Hospital for Special Surgery
York, New York, United States

Submitter(s)

HS

HSS SpineTeam

New York, New York, United States

Disclosure(s):

Robert Merrill, MD: No financial relationships to disclose

Omri Maayan, BS: No financial relationships to disclose

Anthony Pajak, BS: No financial relationships to disclose

Tejas Subramanian, BS: No financial relationships to disclose

Robert Kamil, BS: No financial relationships to disclose

John Clohisy, MD: No financial relationships to disclose

Sravisht Iyer, MD: No financial relationships to disclose

Introduction
While the safety and efficacy of both stand-alone and traditional ALIF have been described, the rate of neurological deficits has been reported to be up to 6.8%. In the absence of iatrogenic injury, postoperative radiculitis, or weakness, appears to be the least predictable complication.

Aims/Objectives
Identify which factors may predict postoperative radiculitis following L5-S1 ALIF.

Methods
Adult patients (18-80 years) with preoperative radiculopathy who underwent L5-S1 (ALIF) with or without posterior fixation by 7 surgeons between 01/2016 and 12/2021 were included. Radiographic parameters were measured preop and at 2-wk, 6-wk, 3-mo, and 6-mo postop. PROMs included ODI, VAS Leg/Back, SF-12 PCS/MCS, and PROMIS at preop, 2-wk, 6-wk, 3-mo, 6-mo, & 1-yr. Multivariable logistic regression was performed with radiculitis as the dependent variable and different independent predictor variables. Statistical significance was taken at p-value < 0.05.

Results
From 140 patients, 48 developed postoperative radiculitis (34%). The average time to symptom onset and resolution was 14.5 and 83 days, respectively. Statistically significant independent predictors of postoperative radiculitis were preoperative Medrol dosepak use (p=0.02, OR=5.07), increased implant height (p=0.002, OR=1.41), and no posterior fixation (p=0.0015, OR=3.98). There were no differences in any pre & postop radiographic parameters between the 2 groups. No differences in preoperative PROMs. Postop between the 2 groups, there were statistically significant differences at 2-wk (leg & back VAS), and 6-wk (all PROMs except SF-12 PCS). There were no differences in any outcomes at 12-wk, 6-mo, or 1-yr.

Conclusions
Preoperative Medrol dosepak use, increased implant height, and no posterior fixation were statistically significant independent predictors of postoperative radiculitis. These findings offer important clinical insight into a poorly understood complication.