Impact of Low-Density Lipoprotein Levels on Rates of Pseudarthrosis After Anterior Cervical Discectomy and Fusion

Study Design. Retrospective cohort study. Objective. To understand how pre-operative LDL levels, statin intake, and fish oil intake affect rates of pseudarthrosis after single-level and multi-level ACDF. Summary of Background Data. Anterior cervical discectomy and fusion (ACDF) is commonly performed to treat cervical degenerative diseases or injuries causing neck pain, myelopathy, and radiculopathy. Pseudarthrosis following ACDF can lead to persistent symptoms and may require revision surgery. No studies have explored the link between low-density lipoprotein (LDL) levels and statin or fish oil intake on pseudarthrosis in ACDF. Methods. Patients undergoing ACDF were identified using TriNetX, a healthcare database with over 100 million patients. Pseudarthrosis rates following single-level and multi-level ACDF were compared between patients with high versus low LDL within one year before surgery. Pseudarthrosis rates were also compared between patients taking or not taking a statin as well as patients taking or not taking fish oil within six months before surgery. For all analyses, patients underwent propensity score matching in a 1:1 ratio based on relevant demographic factors and co-morbidities. Results. Patients with an LDL above 142 mg/dL, compared to below 66 mg/dL, had significantly higher rates of pseudarthrosis at 6-months, 1-year, and 2-years after single-level and multi-level ACDF. Patients not taking a statin or fish oil, compared to those taking a statin or fish oil respectively, also had significantly higher rates of pseudarthrosis at all time points after multi-level ACDF, but not single-level ACDF. Conclusion. Low LDL levels are associated with reduced rates of pseudarthrosis after single-level and multi-level ACDF. Statin and fish oil intake prior to surgery are also associated with reduced rates of pseudarthrosis after multi-level, but not single-level, ACDF. These associations may be used for pre-operative planning, patient optimization, and risk stratification.