Comparison of Outcomes of Oblique Lateral Interbody Fusion with Percutaneous Posterior Fixation in Lateral Position and Minimally Invasive Transforaminal Lumbar Interbody Fusion for Degenerative Spondylolisthesis

Abstract

Single-center retrospective study. Purpose: To compare the physical function and quality of life (QOL) parameters of two minimally invasive surgical (MIS) procedures: oblique lateral interbody fusion with percutaneous posterior fixation in lateral position (OLIF-LPF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for single-level degenerative spondylolisthesis (DS). Overview of Literature: To date, many options for the surgical treatment of lumbar DS and reports have described the effectiveness of minimally invasive lateral access surgery and MIS-TLIF. However, there is still a paucity of comparative data regarding the physical function and QOL outcomes of OLIF and MIS-TLIF. Methods: Eighty-six patients were enrolled in this study (group O: OLIF-LPF, n=38; group T: MIS-TLIF, n=48). We evaluated the operation time, estimated blood loss (EBL), postoperative laboratory data, preoperative and postoperative radiographic parameters, overall functional outcome with the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) effectiveness rate, and Visual Analog Scale (VAS) score for low back pain, leg pain, and leg numbness. Results: No statistical differences in operation time, EBL, and C-reactive protein level, 5 days postoperatively, between groups O and T. With respect to radiological outcome, preoperative and postoperative disc height change was significantly greater in group O than in group T (3.8 vs. 1.8 mm, p<0.05). Both groups showed postoperative improvements in the clinical outcome scores of all JOABPEQ domains, but the effectiveness rate increase in the psychological domain was significantly higher in group O than in group T (47.1% vs. 14.6%, p<0.05). No differences in the preoperative and postoperative VAS score change were noted between the two groups in any of the items.

Transforaminal Lumbar Interbody Fusion (TLIF) versus Oblique Lumbar Interbody Fusion (OLIF) in Interbody Fusion Technique for Degenerative Spondylolisthesis: A Systematic Review and Meta-Analysis

“…Lateral access to the anterior spinal column has some distinct advantages over traditional posterior approaches, including indirect neurologic decompression with minimized tissue damage, decreased blood loss, and shorter surgical times [ 6 , 7 , 8 , 9 , 10 ]. With LLIF, posterior musculature and ligamentous complexes of lumbar spine are not sacrificed.…”

“…Various techniques for interbody fusion, including TLIF and OLIF, have been developed [ 2 , 4 , 12 , 13 , 14 , 29 ]. Several clinical studies and a few meta-analyses have compared postoperative outcomes and complications between the two techniques, TLIF and OLIF [ 3 , 5 , 6 , 7 , 8 , 14 , 26 , 30 , 31 , 40 , 41 , 42 , 43 , 44 ]. However, previous studies did not control for the preoperative conditions requiring lumbar fusion surgery.…”

“…Interbody procedures with cage insertion are essential for lumbar fusion surgery, and techniques for interbody procedure have advanced over time [ 2 , 3 , 4 , 5 ]. Conventionally, cage insertion via the transforaminal route after a posterior approach (transforaminal lumbar interbody fusion, TLIF) has been the gold-standard procedure for interbody fusion; however, the procedure has several drawbacks, including neural injury, endplate violation, cage subsidence, cage migration, and other critical problems [ 3 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ].…”

“…Lateral-access cage insertion techniques via the retroperitoneal space have been invented to reduce the problems related to TLIF procedures, including lateral lumbar interbody fusion (LLIF) or oblique lateral interbody fusion (OLIF) [ 2 , 4 , 7 , 11 , 12 , 13 , 14 , 15 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ]. LLIF is conducted via the intermuscular approach dissecting the psoas muscle; thus, it can cause psoas muscle-related complications, including anterior thigh pain, leg weakness, nerve root injury, and others [ 2 , 4 , 11 , 13 , 14 , 25 , 29 ].…”

“…Based on the concepts of the approaches for interbody fusion, several meta-analyses have compared the effectiveness of TLIF and OLIF in interbody fusion [ 7 , 8 , 31 , 35 , 36 ]. However, the previous analyses have had significant limitations: preoperative conditions requiring lumbar fusion surgery varied, such as foraminal stenosis, deformity, instability, and spondylolisthesis.…”