Higher charlson comorbidity index score correlates with higher rate of pseudoarthrosis following short-segment lumbar fusion surgery

In the present study, we aimed to analyze whether the Charlson Comorbidity Index (CCI) score was predictive for pseudoarthrosis in patients who underwent with short-segment lumbar decompression and fusion for degenerative lumbar spine disorders (DSD).

Consecutive patients who underwent short-segment lumbar decompression and fusion for DSD between 2013 and 2023 in a tertiary spine clinic were included into the study. Patients’ charts were reviewed for patients’ comorbidities, smoking status, and the CCI score was calculated accordingly. Subcutaneous fat index (SFI) was used for the anthropometric evaluation of the participants.

Comorbidities/smoking had no significant effect on the pseudoarthrosis rate, when analyzed separately. However, subjects with pseudoarthrosis at their final follow-up visits had significantly higher CCI scores at the pre-operative era compared to the subjects without pseudoarthrosis (p = 0.022). Besides, in patients with pseudoarthrosis and those without pseudoarthrosis 48.1% and 75.3% were overweight according to SFI, respectively (p = 0.003). Multivariable regression analysis depicted ORs of 1.256 (p = 0.018) for the CCI score and 0.269 (p = 0.003) for overweight. The ROC analysis revealed a cut-off value of 2.5 points for the CCI score.

A combined effect of comorbidities might yield higher pseudoarthrosis rates following short-segment decompression and fusion for DSD. Each one-point increment in CCI score and SFI score yielded a 26% increment and a 73% decrement in risk for pseudoarthrosis in those subjects. A cut-off value of 2.5 points for the CCI score could distinguish the subjects who might have pseudoarthrosis following short-segment surgery for DSD.