Clinical results and complications associated with oblique lumbar interbody fusion technique

Abstract

Background: Oblique lumbar interbody fusion (OLIF) is a minimally invasive technique performed through the antero-oblique trajectory to address a wide range of lumbar pathologies. However, it can lead to complications. We reviewed the results of OLIF and discussed the effective methods to avoid such complications.Methods: Seventy-nine consecutive patients who underwent OLIF between May 2016 and July 2019 were retrospectively analyzed. They were divided into three groups: stand-alone, posterior, and lateral fixation, according to whether they were followed up with auxiliary internal fixation as well as the fixation methods.Preoperative and last follow-up visual analog scale (VAS) and Oswestry Disability Index (ODI) scores were used to assess the improvement in the lower back and leg pain as well as neurological conditions. We analyzed intervertebral disc height (DH), segmental lumbar lordotic angle (SLL), lumbar lordotic angle (LL), pelvic tilt (PT), pelvic incidence-lumbar lordosis (PI-LL) mismatch, and the cross-section area (CSA) on axial magnetic resonance imaging (MRI) image in different groups. Complications, including thigh symptoms, cage subsidence, neurological injury, and vascular injury, were also noted.Results: Seventy-nine patients were followed up postoperatively for 23.2±11.5 (range, 12-48) months.Forty-eight (61%) patients underwent stand-alone surgery (without fixation), 15 (19%) patients underwent supplemental percutaneous pedicle screw fixation (posterior fixation), and 16 (20%) patients underwent lateral vertebral instrumentation (lateral fixation). In all three groups, the VAS score and the ODI score had significantly decreased at the final follow-up compared to pre-operation. The DH, SLL, LL, CSA, PT, and PI-LL mismatch had also improved by final follow-up. The most common approach-related complication was thigh symptoms. Of the 79 patients, ipsilateral transient psoas paresis occurred in 9 (11.4%), ipsilateral transient quadriceps weakness in 2 (2.5%), and groin/thigh numbness and pain in 17 (21.5%). Cage subsidence occurred in 8 (10.1%) patients, including five cases of grade 0, one of grade I, and two of grade II. Three (3.8%) patients in this study had a vascular injury.Conclusions: OLIF is a minimally invasive and effective technique for dealing with degenerative lumbar diseases. However, it should also be noted that this approach carries risks of complications.

Pearls and Pitfalls of Oblique Lateral Interbody Fusion: A Comprehensive Narrative Review

“…The authors suspected that complications associated with psoas muscle injury in DLIF may have contributed to this difference. Other previous studies have also reported significantly higher rates of anterior thigh symptoms (pain, sensory deficit, and hip flexor weakness) in DLIF (30%–40%) than OLIF (1.3%–21.4%) [ 38 , 60 - 62 ]. However, these symptoms are generally transient and resolve at postoperative 3 to 6 months [ 63 ].…”

“…Degenerative disc disease, spinal stenosis, and spondylolisthesis (degenerative and spondylolytic) are common indications for OLIF, and previous studies have reported favorable outcomes following OLIF in these conditions [ 37 , 38 ]. However, there is skepticism among spine surgeons on whether severe lumbar spinal stenosis can be effectively treated by indirect decompression alone [ 39 ].…”

“…Ureteral injury is a rare complication following OLIF, only described in several case reports [ 77 , 78 ]. Most surgeons have reported no case of ureteral injury in their large case series [ 38 , 62 , 79 ]. The ureter, attached to the posterior wall of the peritoneum, is commonly encountered during a retroperitoneal antepsoas approach.…”

“…Delayed subsidence of the interbody cage is a common complication following OLIF [ 38 , 81 ]. The incidence of cage subsidence has been reported to be up to 18.7% when combined with intraoperative endplate violations [ 61 ].…”

Influence of coronal-morphology of endplate and intervertebral space to cage subsidence and fusion following oblique lumbar interbody fusion

“…Maintaining the height of the increased intervertebral space and promoting early intervertebral fusion is vital in maintaining the surgical efficacy of OLIF. However, cage subsidence is the most common complication of OLIF, with an incidence of 10.1%-35.3% [2,3]. In addition, subsidence has a negative effect on interbody fusion [4].…”