Comparison of Long-Term Patient-Reported Outcomes Between Standalone and Pedicle Screw-Fixated Anterior Lumbar Interbody Fusions

Study Design: Single-institution, multi-surgeon retrospective cohort study. Objective: Compare one-year Oswestry Disability Index (ODI) and EuroQol 5-D (EQ. 5D) scores between ALIFs with and without pedicle screw fixation (PSF) and identify demographic predictors of outcomes. Summary of Background Data: PSF supplementation of anterior lumbar interbody fusions (ALIF) remains the standard for patients with complex pathology and instability. Standalone ALIF procedures forgo PSF application, minimizing surgical trauma to the posterior anatomy at the expense of construct stability. It is unclear if PSF affects long-term patient-reported outcomes (PROs) in patients without considerable instability. Methods: Patients aged 18 to 89 who underwent a one-level or two-level ALIF between March 2015 and December 2023 for a diagnosis of disc degeneration, spondylosis, or spinal stenosis were included. Cases were grouped into standalone ALIF (SA-ALIF) or pedicle screw-fixated ALIF (PSF-ALIF) cohorts. Outcomes were assessed with multivariable regression. Backward stepwise multivariable linear regression with listwise deletion identified predictors of one-year PRO scores in each cohort. Results: Analysis included 396 ALIFs with 234 (59.1%) PSF-ALIFs and 162 (40.9%) SA-ALIFs. PSF-ALIF patients were older, with higher BMI and comorbidity burden. Both groups improved significantly in ODI and EQ. 5D scores at one year ( P <0.001). ODI scores did not differ between groups, but PSF-ALIFs had higher one-year EQ. 5D scores (75.7±18.8 vs. 67.8±19.5, P =0.007) and improvement from baseline (18.5±16.7 vs. 13.9±19.1, P =0.013). Among PSF-ALIFs, higher CCI predicted improved ODI scores ( P =0.010). In SA-ALIFs, smoking predicted worse ODI ( P =0.021) and EQ. 5D ( P =0.012), and higher BMI predicted worse EQ. 5D ( P =0.039). Conclusions: Supplementation with pedicle screws can increase the quality of life of ALIF patients with stable degenerative pathology. PSF may be beneficial for active smokers and those of higher BMI, but may be limiting for healthier patients. Level of Evidence: Level III.