Clinical and Radiographic Comparisons among Minimally Invasive Lumbar Interbody Fusion: A Comparison with Three-Way Matching

Abstract

To compare clinical and radiographic outcomes among minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), extreme lateral lumbar interbody fusion (XLIF), and oblique lateral lumbar interbody fusion (OLIF) techniques. Overview of Literature: To date, there are many reports comparing outcomes between MIS-TLIF and XLIF, MIS-TLIF and OLIF, or XLIF and OLIF procedures. However, there are no previous studies comparing clinical and radiographic outcomes among all these three techniques. Methods: Data from patients who underwent minimally invasive (MI) fusion surgery for lumbar degenerative diseases at L4-L5 level was analyzed. Thirty patients each from MIS-TLIF, XLIF, and OLIF groups were recruited for propensity score matching. Visual Analog Scale (VAS) of the back and legs and Oswestry Disability Index (ODI) were evaluated preoperatively and at 1, 3, and 6 months and 1 year postoperatively. Radiographic outcomes were also compared. The fusion rate was evaluated at 1 year after surgeries. Results: The clinical outcomes were significantly improved in all groups. The disk height was significantly restored in all groups postoperatively, which was significantly more improved in XLIF and OLIF than MIS-TLIF group (p<0.001). The axial canal area was significantly increased more in MIS-TLIF versus XLIF and OLIF (p<0.001). The correction of lumbar lordotic angle and segmental sagittal angle were similar among these techniques. OLIF and XLIF groups showed less blood loss and shorter hospital stays than MIS-TLIF group (p<0.001). There was no significant difference in fusion rate among all groups. Conclusions: MIS-TLIF, XLIF, and OLIF facilitated safe and effective MI procedures for treating lumbar degenerative diseases. XLIF and OLIF can achieve clinical outcomes equivalent to MIS-TLIF by indirect decompression. XLIF and OLIF showed less blood loss, shorter hospital stays, and better disk and foraminal height restorations. In single-level L4-5, the restoration of sagittal alignment was similar between these three techniques.

Comparing clinical and radiological outcomes between single-level OLIF and XLIF: A systematic review and meta-analysis

“…Our study found no significant differences between the 2 cohorts in terms of average blood loss and operative time. Our results are consistent with a majority of the studies comparing both single and multilevel fusions that demonstrated no significant differences in perioperative outcomes [8 , 9 , 14 , 37] . These findings may be attributable to the fact that OLIF and XLIF are similar anterolateral techniques that both involve dissection through the retroperitoneal space to gain access to the vertebral disc.…”

“…[ 35 ] 20 Retrospective L3–L5 45/55 69.0 III XLIF Studies 602 Yingsakmongkol et al. [ 14 ] 30 Retrospective L4–L5 27/73 63.53 III Li et al., 2021 [23] 54 Prospective observational L3–L5 35/65 60.3 II 41 Prospective observational L3–L5 49/51 57.9 II Hiyama et al. [ 27 ] 80 Retrospective L1–L5 60/40 71.6 III Jung et al.…”

“…After removing duplicates and applying inclusion and exclusion criteria, 24 studies were included in the final analysis ( Fig. 1 ) [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] .

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Lumbar Interbody Fusion and Osteobiologics for Lumbar Fusion

“…Correction of sagittal as well as coronal deformities can be achieved using lordotic and big cages [72][73][74][75][76]. Furthermore, LLIF has been demonstrated to restore foraminal height and central canal surface through indirect decompression [76][77][78][79]. However, LLIF has disadvantages, including damage to the psoas, internal organs, or lumbar plexus [72,80].…”

Recent Updates on Minimally Invasive Spine Surgery: Techniques, Technologies, and Indications

“…TLIF can be performed through a minimally invasive approach using a microscope with a tubular retractor or an endoscope. Compared with PLIF, minimally invasive TLIF can minimize damage to structures that contribute to posterior stability such as interspinous ligaments, contralateral facet joints, and paravertebral muscles [ 21 ].…”