Resident Physician University of Cincinnati, Department of Neurosurgery Cincinnati, Ohio, United States
Introduction: Ehlers-Danlos syndrome (EDS) is a collection of connective tissue disorders which are often associated with tissue laxity and disc degeneration. However, the implications of EDS on the risk of adjacent segment disease (ASD) after transforaminal lumbar interbody fusion (TLIF) are not well described. The objective of this study is to compare the rates of ASD among patients with EDS and those without EDS.
Methods: Patients who underwent 1-3 level TLIF for degenerative disc disease between 2010-2022 were identified using the PearlDiver Mariner all-claims insurance database. Patients with all types of EDS were included. Patients undergoing surgery for tumors, trauma, or infection were excluded. 1:1 propensity matching was performed using demographic factors, medical comorbidities, and surgical factors which were significantly associated with ASD in a linear regression model. The primary outcome measure was development of ASD. The secondary outcomes were the development of pseudoarthrosis, medical complications, and surgical complications.
Results: Propensity matching resulted in two equal groups of 1126 patients who did or did have EDS and underwent 1-3 level TLIF. Patients with EDS were more likely to experience ASD (RR 3.694, 95% CI 3.037-4.494, p< 0.001) Similarly, EDS was associated with higher rates of all-cause surgical complications (RR 1.889, 95% CI 1.073-3.324, p=0.035), all-cause medical complications (RR 2.280, 95% CI 1.652-3.146, p< 0.001), and pseudoarthrosis (RR 2.50, 95% CI 1.598-3.910, p< 0.001).
Conclusion : After propensity matching to control for confounding variables, the findings of this study suggest that EDS is associated with an increased risk of ASD following TLIF. EDS was also found to be associated with increased risk of pseudoarthrosis, medical complications, and surgical complications
