Can oblique lateral interbody fusion (OLIF) create more lumbosacral lordosis in lumbar spine surgery than minimally invasive transforaminal interbody fusion (MIS-TLIF)?

Abstract

ObjectiveTo compare the differences in the correction effect for lumbosacral lordosis and clinical outcomes between OLIF with/without posterior pedicle screw fixation (PSF) and MIS-TLIF through a retrospective cohort study.MethodThere were 98 consecutive patients originally enrolled for the study, but 15 patients were excluded due to intraoperative endplate injury or osteotomy performed for severe spinal deformity. Thus, 83 patients included in this study (36 males and 47 females, mean age 65.8 years) underwent single to three-segment OLIF (including OLIF + PSF and OLIF Standalone) or MIS-TLIF surgery from 2016 to 2018. The operation time, bleeding and blood transfusion, fusion rate, complication, pre-and postoperative visual analogue scale (VAS), Oswestry Disability Index (ODI) were evaluated. In addition, radiological parameters including lumbosacral lordosis (LL), fused segment lordosis (FSL), anterior disc height (ADH) and posterior disc height (PDH) were measured. The clinical outcomes, LL, FSL, ADH and PDH restored and were compared between the OLIF group, OLIF subgroups and MIS-TLIF group.ResultsThe average operation time and intraoperative bleeding were significantly less in the OLIF group than in the MIS-TLIF group (163 ± 68 vs. 233 ± 79 min, 116 ± 148 vs. 434 ± 201 ml, P < 0.001). There was no statistically significant difference between the OLIF group and the MIS-TLIF group in VAS and ODI improvements, fusion rate, complication, LL and FSL correction (P > 0.05). The ADH and PDH increases in the OLIF group were more than that in MIS-TLIF group (P < 0.001). The correction of LL was significantly more in the OLIF + PSF group than in the MIS-TLIF group (9.9 ± 11.1 vs. 4.2 ± 6.1deg, P = 0.034).ConclusionOLIF and MIS-TLIF are both safe and effective procedures, capable of restoring lumbosacral lordosis and disc height partly. Combined with PSF, OLIF can achieve a better correction effect of lumbosacral lordosis than MIS-TLIF.

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

“…Controversy persists over whether there is a difference in complication rates between OLIF and Mis-TLIF. 15 16 17 18 19 20 21 22 23 24 25 26 27 28 The complication rate in the OLIF group (21.9%) was higher than that in the Mis-TLIF group (11.2%), although the difference was not statistically significant. Serious complications cannot be ignored.…”

“…33 Although it is an indirect decompression modality, OLIF has been shown to be clinically equivalent to Mis-TLIF for the treatment of DLS and DLSS. [15][16][17][18][19][20][21][22][23][24][25][26][27][28] OLIF was performed through an oblique lateral approach. The intervertebral disk nucleus pulposus and cartilaginous endplate were thoroughly removed.…”

“…[11][12][13][14] To date, some studies have compared the clinical and radiologic outcomes of OLIF with Mis-TLIF or TLIF in patients with DLS or degenerative lumbar spinal stenosis (DLSS). [15][16][17][18][19][20][21][22][23][24][25][26][27][28] Although clinical efficacy comparable to Mis-TLIF or TLIF can be achieved, most studies have reported that posterior fixation is often required after OLIF to reduce the risk of cage displacement or subsidence. 29 However, compared with lateral fixation, posterior fixation can significantly increase OT and surgical trauma, thus making the surgery more cumbersome.…”

Fusion rate and complications of oblique lumbar interbody fusion and transforaminal lumbar interbody fusion in the treatment of lumbar degenerative diseases: a meta-analysis

“…Fusion rates were reported in 11 studies ( 4 , 5 , 7 , 8 , 10 , 12 , 14 , 15 , 17 , 18 , 21 ), and a total of 948 patients, of whom 466 belonged to the OLIF group and 482 belonged to the TLIF group. The heterogeneity between the studies was not significant ( I 2 = 0%, P = 0.44); thus, the FEM was used for the combined analysis.…”