OLIF versus MI-TLIF for patients with degenerative lumbar disease: Is one procedure superior to the other? A systematic review and meta-analysis

Radiological Outcomes and Approach-Related Complications in Oblique Lateral Interbody Fusion at the Upper Lumbar Level

Background/Objectives: Despite recent advances in minimally invasive extrapleural lateral approaches, oblique lateral interbody fusion (OLIF) at the upper lumbar level is often difficult and limited to optimal reconstruction. We aimed to compare the radiological outcomes and approach-related complications of OLIF between the upper (L1-2 or L2-3) and lower (L3-4 or L4-5) levels. Methods: This study is a retrospective review of OLIF in the upper (n = 63) and lower (n = 60) lumbar level groups. Radiological parameters included the anterior/posterior disc height, coronal/sagittal disc angle, cage position, cage subsidence, and fusion rate at a postoperative 1-year follow-up. Approach-related complications including pleural/peritoneal lacerations, neurovascular injury, and other organ injuries were examined. Results: The baseline radiological parameters were similar between the two groups (all p > 0.05). At 1-year postoperatively, the anterior disc height (ADH) was significantly greater in the lower-level group (p = 0.031), while no significant differences were observed in the posterior disc height, coronal/sagittal disc angle, cage anterior position, or cage subsidence rate (all p > 0.05). The fusion rates were 97.9% and 95.0% at the upper and lower lumbar levels, respectively (p = 0.146). During OLIF at the upper lumbar level, chest tube insertion due to pleural laceration was observed in 11 (17.5%) cases. One case (1.2%) of segmental artery injury and two cases (3.2%) of pseudo-hernia were attributed to iliohypogastric nerve injury. Conclusions: Although the extrapleural approach in OLIF at the upper lumbar level is often limited, the radiological outcomes were comparable to those of OLIF at the lower lumbar level.

Comparing OLIF Combined with Lateral Screw Fixation versus Minimally Invasive TLIF for Treating Single-Level Degenerative Lumbar Spondylolisthesis: A Retrospective Cohort Study

BACKGROUND

 The present study aimed to compare the clinical and radiologic outcomes of oblique lumbar interbody fusion (OLIF) combined with lateral screw fixation and minimally invasive transforaminal lumbar interbody fusion (Mis-TLIF) for the treatment of single-level degenerative lumbar spondylolisthesis (DLS).

METHODS

 Data regarding clinical and radiologic outcomes for single-level DLS treated using OLIF combined with lateral screw fixation or Mis-TLIF between November 2017 and June 2020 were retrospectively analyzed.

RESULTS

 Seventy-five patients with single-level DLS (≥2 years' follow-up) were included and divided into two groups according to the surgical method used: OLIF (n = 33) and Mis-TLIF (n = 42). Operative time, intraoperative blood loss, and length of hospital stay were significantly lower in the OLIF group than that in the Mis-TLIF group. There were no significant differences in preoperative low back pain (LBP), leg pain (LP), visual analog scale (VAS) scores, and Oswestry Disability Index (ODI) between the two groups, although the OLIF group had significantly lower LBP VAS scores at 1, 3, and 6 months postoperatively. Additionally, the LP VAS score was significantly lower in the Mis-TLIF group than that in the OLIF group at 1 month postoperatively, and the ODI of the OLIF group at 3 months postoperatively was significantly lower than that of the Mis-TLIF group. There was no significant difference in the preoperative and postoperative lumbar lordosis angles between the two groups, whereas the postoperative surgical segmental lordosis angle and disk height (at 1, 6, 12, and 24 months) in the OLIF group were significantly higher than those in the Mis-TLIF group. Additionally, there was no significant difference in complication rates between the two groups (18.2% in the OLIF group vs. 11.9% in the Mis-TLIF group; p = 0.520).

CONCLUSION

 OLIF combined with lateral screw fixation yielded better clinical and radiologic outcomes than Mis-TLIF in patients with single-level DLS.

Effect of Approach Based Lumbar Interbody Fusion on Sagittal Spinopelvic Parameters and Functional Outcomes: Comparison between Oblique Lumbar Interbody Fusion (OLIF) and Transforaminal Lumbar Interbody Fusion (TLIF)

PURPOSE

Transforaminal lumbar interbody fusion (TLIF) and oblique lumbar interbody fusion (OLIF) are the most commonly conducted operations for interbody fusions. In addition to fusion, the restoration of proper spinal alignment has become crucial for achieving favorable functional outcomes. There is a lack of agreement on which lumbar interbody fusion technique provides the most effective correction for sagittal spinopelvic parameters (SSPs). This study aims to investigate the functional outcome in terms of SSPs in patients undergoing single level OLIF and TLIF for lumbar degenerative disc disease.

METHODOLOGY

Retrospective analysis of single level OLIF or TLIF was done. The patients' index and follow-up data until 6 months of surgery were collected. Radiographic parameters analysis included disc height (DH), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), pelvic index, lumbar lordosis (LL), segmental lordosis (SL). Clinical outcomes were recorded using visual analogue scale (VAS) and Oswestry Disability Index (ODI).

RESULTS

In a total of 38 patients (19 in each group) mean age was 51.52 ± 12.67 years in OLIF and 52.17 ± 9.73 years in TLIF. Improvement in DH was more in OLIF but not statistically significant (p = 0.075). Significant improvements were seen in PT, and SL post-TLIF. Change in SSPs among groups shown no significant differences. Both VAS and ODI shown improvements in both the groups but no significant difference was noted while comparing the two groups.

CONCLUSION

The study showed better restoration of SSPs by TLIF in terms of PT and SL although functional outcomes appear similar in both procedures. Increase in DH is the important determinant for resulting good outcome. Patients with maintained spinopelvic balance can be treated satisfactorily with less-invasive OLIF.

Risk Factors of Unsatisfactory Outcomes Requiring Additional Intervention Following Oblique Lateral Interbody Fusion

OBJECTIVE

Oblique lateral interbody fusion (OLIF) is a minimally invasive procedure for stabilizing the spine and indirectly decompressing the neural elements. There is sparse data on unsatisfactory outcomes that require additional interventions (surgery or intervention) after OLIF. This study aimed to identify the causes, and risk factors of these reintervention.

METHODS

This was a single-center retrospective study of the patients who underwent the OLIF procedure from June 2016 to March 2023. Several clinical and radiographic parameters were studied. We also analyzed associations between several potential risk factors and the reintervention following OLIF.

RESULTS

A total of 231 patients were included. Over an average of 2.5 years of follow-up, 28 patients (12.1%) required a reintervention. Adjacent segment disease (ASD) was the most common cause of reintervention. The risk factors associated with reintervention were previous surgery (adjusted odds ratio [aOR], 4.44; 95% confidence interval [CI], 1.21-16.33; p=0.02) and high preoperative Oswestry Disability Index (ODI) scores (aOR, 1.04; 95% CI, 1.00-1.08; p=0.03). Although increasing the duration of follow-up was not statistically significant, the 95% CI was consistent with an increased risk of reintervention with longer follow-up (OR, 1.18; 95% CI, 0.94-1.50).

CONCLUSION

This study showed that patients with prior lumbar surgery and high preoperative ODI scores were more likely to require additional intervention after the OLIF procedure. In addition, an increasing duration of follow-up was associated with an increased risk of reintervention. The most common reason for reintervention was ASD after OLIF.

Does indirect decompression by oblique lateral interbody fusion produce similar clinical and radiological outcomes to direct decompression by open transforaminal lumbar interbody fusion

OBJECTIVES

Open transforaminal lumbar interbody fusion (O-TLIF) remains the most popular and widely practiced lumbar fusion method even today, providing direct decompression. Oblique lateral interbody fusion (OLIF) is a novel retroperitoneal approach that allows placement of a large interbody cage which provides an indirect neural decompression, and screws can be placed minimal invasively or through the Wiltse OLIF (W-OLIF) approach. We aim to find out the short-term efficacy of W-OLIF to O-TLIF in terms of radiological and clinical outcomes in patients of lumbar degenerative diseases.

MATERIALS AND METHODS

Fifty-two patients were divided equally into two groups (group O-TLIF and group W-OLIF). Several parameters were measured, such as the spinal cord cross-sectional area (SC-CSA), foraminal cross-sectional area (F-CSA), disc height (DH), foraminal height (FH), Schizas grade for stenosis, and Meyerding's grading for olisthesis. Functional scores were measured using the visual analog scale (VAS) for low back pain (LBP) and lower limbs, Oswestry Disability Index. All parameters were repeat measured at 3 months follow-up. Statistical analysis was done using SPSS software.

RESULTS

Both groups were similar in composition preoperatively. There was significant improvement in all clinical and radiological parameters post-surgery in either group. However, at 3 months, The DH, FH, FSA, and VAS (LBP) were better in the W-OLIF group than in O-TLIF. Procedure-related complications were seen in both groups (15% in the O-TLIF group and 19% in the W-TLIF group), but only one patient in O-TLIF required revision due to cage migration.

CONCLUSION

Similar improvement occurs in most of the clinical and radiological parameters in the W-OLIF group compared to the O-TLIF group. Few radiological parameters such as the DH, FH, and F-CSA and the VAS (LBP) correction are superior in the W-OLIF group in the short-term follow-up. We conclude that indirect decompression by W-OLIF provides equivalent, if not better, results than the traditional O-TLIF lumbar fusion.

Clinical, Radiographic and Fusion Comparison of Oblique Lumbar Interbody Fusion (OLIF) stand-alone and OLIF with posterior pedicle screw fixation in patients with degenerative spondylolisthesis

PURPOSE

To compare the outcomes and characteristics of oblique lumbar interbody fusion stand-alone (OLIF-SA) and OLIF with posterior pedicle screw fixation (OLIF-PPS) in the treatment of Grade I or Grade II degenerative lumbar spondylolisthesis.

PATIENTS AND METHODS

Between January 2019 and May 2022, 139 patients with degenerative spondylolisthesis were treated with OLIF-SA (n = 85) or OLIF-PPS (n = 54). The clinical and radiographic records were reviewed.

RESULTS

The clinical and radiographic outcomes were similar in both groups. The operative time and intraoperative blood loss in the OLIF-SA group were lower than those in the OLIF-PPS group (P < 0.05). However, the OLIF-PPS group had significantly better disc height (DH) and postoperative forward spondylolisthesis distance (FSD) improvement at 6 months (P < 0.05). The OLIF-PPS group had a significantly lower cage subsidence value than the OLIF-SA group (P < 0.05). Improvement of the lumbar lordotic angle (LA) and fusion segmental lordotic angle (FSA) in the OLIF-PPS group was significantly better than that in the OLIF-SA group (P < 0.05). In terms of fusion types, the OLIF-SA group tended to undergo fusion from the edge of the vertebral body. Fusion in the OLIF-PPS group began more often in the bone graft area of the central cage of the vertebral body. The fusion speed of the OLIF-SA group was faster than that of the OLIF-PPS group.

CONCLUSION

OLIF-SA has the advantages of a short operative time, less intraoperative blood loss, and reduced financial burden, while PPS has incomparable advantages in the reduction of spondylolisthesis, restoration of lumbar physiological curvature, and long-term maintenance of intervertebral DH. In addition, the SA group had a unique vertebral edge fusion method and faster fusion speed.

Minimally Invasive Transforaminal Lumbar Interbody Fusion: Strategies for Creating Lordosis with a Posterior Approach

The purpose of this article is to review the outcomes concerning lumbar lordosis restoration after the MIS-TLIF and to present strategies to create lumbar lordosis by using this MIS posterior approach. MIS-TLIF is an effective MIS lumbar interbody fusion that can achieve lumbar lordosis restoration. Several crucial steps aid in this sagittal profile correction during the MIS-TLIF, including the appropraite prone positioning, optimizing disc space preparation, maximizing disc space height, anterior interbody cage placement, and reducing the spondylolisthesis.