Severe abdominal aortic calcification is associated with poor two‑year outcomes after posterior lumbar interbody fusion in osteoporotic patients: a retrospective cohort study

Abstract

To investigate whether preoperative abdominal aortic calcification (AAC) severity assessed on lateral lumbar radiographs is associated with 2year clinical and radiographic outcomes in osteoporotic patients who have undergone posterior lumbar interbody fusion (PLIF) for the treatment of lumbar degenerative diseases, and whether it may serve as a practical, low-cost risk indicator for risk stratification. A retrospective analysis was conducted on patients with lumbar spinal stenosis or spondylolisthesis who underwent PLIF between January 2021 and September 2023. AAC severity was evaluated on preoperative lateral lumbar radiographs using the 24-point Kauppila scoring system, and patients were stratified into three groups: no AAC (score 0, n=40), moderate AAC (score 1–4, n=32), and severe AAC (score ≥5, n=24). Baseline characteristics, perioperative data, serial clinical scores (VAS, JOA, and ODI), and radiographic parameters were compared. Multivariate linear regression analyses were performed to identify factors associated (statistically, after adjustment for the available covariates) with 2‑year improvements in clinical outcomes. The three groups were comparable in terms of all baseline characteristics and intraoperative variables (all P > 0.05). At the 2-year follow-up, the severe AAC group had significantly worse clinical outcomes, including higher VAS scores and lower JOA scores (both P < 0.001), while the ODI scores were similar across the groups. Radiographic analysis revealed that the severe AAC group also had a significantly lower average surgical disc height (ASDH) at 2 years (P = 0.002) and a worse distribution of interbody fusion grades (P = 0.027). Multivariate analysis confirmed that after adjustment for available covariates, severe AAC remained significantly associated with less improvement in both the VAS score (β = -1.585, P < 0.001) and the JOA score (β = 4.392, P < 0.001) at 2 years. Severe preoperative AAC was statistically associated with poorer 2‑year pain relief, functional recovery, and fusion quality after PLIF in osteoporotic patients. Although this association should not be interpreted as causal due to the retrospective design, routine AAC assessment on lateral radiographs remains a simple, cost‑effective risk stratification tool, especially when comprehensive frailty evaluation is unavailable.Keywords: Abdominal aortic calcification; Osteoporosis; Lumbar degenerative disease; Posterior lumbar interbody fusion; Clinical outcomes