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. 2025 Jul;15(6):2931-2937.
doi: 10.1177/21925682251316555. Epub 2025 Feb 4.

Complications and Clinical Outcomes of Anterior Lumbar Interbody Fusion in Patients With Primary Hypercoagulable Disorders

Henry Avetisian  1 , Will Karakash  1 , Maya Abu-Zahra  1 , Chimere Ezuma  1 , Mirbahador Athari  1 , Marc A Abdou  1 , Dil Patel  1 , Jeffrey C Wang  1 , Raymond J Hah  1 , Ram K Alluri  1
Affiliations

Complications and Clinical Outcomes of Anterior Lumbar Interbody Fusion in Patients With Primary Hypercoagulable Disorders

Henry Avetisian et al. Global Spine J. 2025 Jul.

Abstract

Study DesignRetrospective cohort study.ObjectivesTo evaluate the complications of anterior lumbar interbody fusion (ALIF) in patients with primary hypercoagulable disorders and to compare outcomes between anterior and posterior spine fusions in this patient population.MethodsThe PearlDiver national patient database was queried for patients with primary hypercoagulable disorders who underwent ALIF. Primary endpoints included the prevalence of hypercoagulable disorders in patients who underwent ALIF, incidence of perioperative anticoagulation utilization, as well as the 30-day risks of postoperative complications, readmissions, and revision surgeries. Multivariate regression analysis was conducted to compare outcomes between hypercoagulable patients and non-hypercoagulable patients undergoing ALIF and between hypercoagulable patients undergoing anterior vs posterior lumbar fusion.ResultsOf the 211,390 patients who underwent ALIF, 3380 (1.60%) had a hypercoagulable disorder, with only 6.72% receiving perioperative anticoagulation. Within 30 days of ALIF, hypercoagulable disorders were identified as independent risk factors for hospital readmissions and both medical and surgical complications. Compared to posterior spine fusions, the anterior approach poses a greater risk for complications in this patient population.ConclusionsPatients with hypercoagulable disorders undergoing ALIF are at increased risk for readmissions and postoperative complications compared to those with normal coagulation profiles. While the posterior approach may be a safer option in this patient population, further research is needed to clarify the safest surgical approach for this high-risk population.

Keywords: ALIF; anterior lumbar interbody fusion; complications; hyper-coagulability; retrospective cohort study; risk factors.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Henry Avetisian, Will Karakash, Maya Abu-Zhara, Chimere Ezuma, Mirbahador Athari, and Dil Patel have nothing to disclose. Jeffrey C. Wang has received intellectual property royalties from Zimmer Biomet, NovApproach, SeaSpine, and DePuy Synthes. Raymond J. Hah has received grant funding from SI bone, consulting fees from NuVasive, and support from the North American Spine Society to attend meetings. Ram K. Alluri has received grant funding from NIH, consulting fees from HIA Technologies, and payment from Eccential Robotics for lectures and presentations.

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