Anterior lumbar compared to oblique lumbar interbody approaches for multilevel fusions to the sacrum in adults with spinal deformity and degeneration

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>In adult spinal deformity and degenerative conditions of the spine, interbody fusion to the sacrum often is performed to enhance arthrodesis, induce lordosis, and alleviate stenosis. Anterior lumbar interbody fusion (ALIF) has traditionally been performed, but minimally invasive oblique lumbar interbody fusion (OLIF) may or may not cause less morbidity because less retraction of the abdominal viscera is required. The authors evaluated whether there was a difference between the results of ALIF and OLIF in multilevel anterior or lateral interbody fusion to the sacrum.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>Patients from 2013 to 2018 who underwent multilevel ALIF or OLIF to the sacrum were retrospectively studied. Inclusion criteria were adult spinal deformity or degenerative pathology and multilevel ALIF or OLIF to the sacrum. Demographic, implant, perioperative, and radiographic variables were collected. Statistical calculations were performed for significant differences.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Data from a total of 127 patients were analyzed (66 OLIF patients and 61 ALIF patients). The mean follow-up times were 27.21 (ALIF) and 24.11 (OLIF) months. The mean surgical time was 251.48 minutes for ALIF patients and 234.48 minutes for OLIF patients (p = 0.154). The mean hospital stay was 7.79 days for ALIF patients and 7.02 days for OLIF patients (p = 0.159). The mean time to being able to eat solid food was 4.03 days for ALIF patients and 1.30 days for OLIF patients (p &lt; 0.001). After excluding patients who had undergone L5–S1 posterior column osteotomy, 54 ALIF patients and 41 OLIF patients were analyzed for L5–S1 radiographic changes. The mean cage height was 14.94 mm for ALIF patients and 13.56 mm for OLIF patients (p = 0.001), and the mean cage lordosis was 15.87° in the ALIF group and 16.81° in the OLIF group (p = 0.278). The mean increases in anterior disc height were 7.34 mm and 4.72 mm for the ALIF and OLIF groups, respectively (p = 0.001), and the mean increases in posterior disc height were 3.35 mm and 1.24 mm (p &lt; 0.001), respectively. The mean change in L5–S1 lordosis was 4.33° for ALIF patients and 4.59° for OLIF patients (p = 0.829).</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Patients who underwent multilevel OLIF and ALIF to the sacrum had comparable operative times. OLIF was associated with a quicker ileus recovery and less blood loss. At L5–S1, ALIF allowed larger cages to be placed, resulting in a greater disc height change, but there was no significant difference in L5–S1 segmental lordosis.</jats:p></jats:sec>

Correcting Degenerative Lumbar Spine Deformity by Stand-Alone Anterior Oblique Lumbar Interbody Fusion

“…The mean age for the patients was 50.54 ± 6.05 years, 50% were males and 50% were females, and the mean duration of the symptoms was 34.44 ± 16.68 months. Xi et al 32 in ODI and VAS as well. 36 Kanno et al 19 , in a case report study in 2014, showed a successful improvement in a series of back pain and leg pain of 2 cases with spinal stenosis at levels L5/S1.…”

The Morphological Changes in Adjacent Segments Amongst Patients Receiving Anterior and Oblique Lumbar Interbody Fusion: A Retrospective Study

“…However, when approaching segments above L4 in ALIF, vessel injuries could be the greatest concern [ 18 ]. At L5/S1, there no significant difference in LL and patient-reported outcomes, whether choosing either ALIF or OLIF for correction [ 33 ]. Despite studies claiming the potential of OLIF at L5/S1 level, with promising outcomes, especially in obese patients when ALIF bears higher risk, we preferred to choose ALIF when encountering L5/S1 surgery due to its better visualization and the easier approach at this level [ 34 , 35 ].…”

Radiological outcomes of Lateral Lumbar Interbody Fusion (LIF) in Adult Spinal Deformity – A Systematic Review

“…ALIF and OLIF are very useful techniques at LS junction for restoring lumbosacral lordosis, by allowing placement of larger lordotic cages. Xi et al 47 reported comparable segmental lordosis by using the ALIF and OLIF techniques. Anand et al 4 reiterated the importance of achieving maximal correction of SL at LS junction using multi-level OLIF, especially at L5-S1.…”