Impact of Hyperlipidemia and Lipid-Lowering Agents on Pseudarthrosis Rates After Single-Level and Multi-Level Anterior Lumbar Interbody Fusion.

Abstract

Retrospective cohort study. To investigate how pre-operative low-density lipoprotein (LDL) levels and intake of statin, fish oil, or ezetimibe affect rates of pseudarthrosis after single-level and multi-level anterior lumbar interbody fusion (ALIF). ALIF may be performed to treat degenerative disc disease, spondylolisthesis, spinal instability, and deformity. Pseudarthrosis is a concern following ALIF due to the high axial load and segmental motion of the lumbar spine. Hyperlipidemia can affect fusion rates by limiting blood flow to the surgical site and stimulating systemic inflammation. No studies have explored the association between pre-operative LDL levels and statin, fish oil, or ezetimibe intake on pseudarthrosis in ALIF. TriNetX was used to query patients undergoing ALIF. Pseudarthrosis rates at 6 months, 1 year, and 2 years following single-level and multi-level ALIF were compared between patients with high (≥140 mg/dL) and low LDL (≤66 mg/dL). Patients were also compared based on intake of fish oil, statin, or ezetimibe. Cohorts underwent 1:1 propensity score matching to limit confounding. Patients with low LDL and those taking a statin had lower rates of pseudarthrosis at all time points within 2 years after multi-level ALIF but not single-level ALIF. Pre-operative statin intake was associated with lower LDL levels after single- and multi-level ALIF. Fish oil and ezetimibe were not associated with risk of pseudarthrosis. Pre-operative LDL levels and intake of a statin may modulate risk of pseudarthrosis after multi-level ALIF. Given the relatively low-risk profile of statins and modifiable nature of LDL levels, these findings highlight potentially important areas for multi-disciplinary patient optimization and risk stratification. IV.