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. 2025 Nov;15(8):3861-3868.
doi: 10.1177/21925682251334122. Epub 2025 Apr 14.

Staged Versus Same-Day Circumferential Lumbar Fusion for Degenerative Disease: Which is the Safer Approach?

Henry Avetisian  1 , Mirbahador Athari  1 , William Karakash  1 , Jordan O Gasho  1 , Matthew C Gallo  1 , Jeffrey C Wang  1 , Raymond J Hah  1 , Ram K Alluri  1
Affiliations

Staged Versus Same-Day Circumferential Lumbar Fusion for Degenerative Disease: Which is the Safer Approach?

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

Abstract

Study DesignRetrospective cohort study.ObjectivesTo evaluate utilization trends and outcomes of same-day vs staged circumferential lumbar fusion (cLF) in lumbar degenerative disease.MethodsThe PearlDiver national database was queried for patients with lumbar degenerative disease who underwent same-day or staged cLF, defined as anterior lumbar interbody fusion followed by posterior fusion within 1 to 14 days after. Annual utilization trends (2010-2021) were analyzed. Multivariate regression adjusted for age, gender, comorbidity index, obesity, smoking, and multi-level PSF was used to evaluate 30-day complications, readmissions, and revision rates at 1 and 2 years.ResultsOf 45,204 patients undergoing cLF, 40,052 (88.60%) underwent same-day cLF, and 5152 (11.40%) underwent staged procedures. Patients who underwent staged procedures had higher comorbidity rates and longer fusion constructs. Annual utilization of staged cLF increased on average by 3.76% from 2010. Staged procedures had higher risks of 30-day readmissions (aOR: 1.14), infection (aOR: 1.38), DVT (aOR: 2.62), epidural hematoma (aOR: 1.73), seroma (aOR:1.77), AKI (aOR: 1.34), cardiac arrest (aOR: 2.45), blood loss anemia (aOR: 1.56), urinary retention (aOR: 1.50), UTI (aOR: 1.36), ileus (aOR: 1.64), durotomy (aOR: 4.67), mechanical complications (aOR: 3.39), and blood transfusions (aOR: 2.57) (all P < 0.05). No significant differences in revision rates were found.ConclusionStaged cLF, utilized in 11.40% of cases, particularly for longer fusions and patients with higher comorbidity risk, is associated with higher risks of hospital readmissions and complications, but is not an independent risk factor. Further research is needed to identify patients who may benefit most from staging.

Keywords: circumferential; complications; degenerative; fusion; lumbar.

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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, Mirbahador Athari, William Karakash, Jordan O. Gasho, and Matthew C. Gallo 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.

Figures

Figure 1.
Figure 1.
Annual utilization trends of staged cLF.
See this image and copyright information in PMC

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