Learning Curve and Complications Experience of Oblique Lateral Interbody Fusion : A Single-Center 143 Consecutive Cases

Abstract

Objective : Oblique lateral interbody fusion (OLIF) is becoming the preferred treatment for degenerative lumbar diseases. As beginners, we performed 143 surgeries over 19 months. In these consecutive cases, we analyzed the learning curve and reviewed the complications in our experience. Methods : This was a retrospective study; however, complications that were well known in the previous literature were strictly recorded prospectively. We followed up the changes in estimated blood loss (EBL), operation time, and transient psoas paresis according to case accumulation to analyze the learning curve. Results : Complication-free patients accounted for 43.6% (12.9%, early stage 70 patients and 74.3%, late stage 70 patients). The most common complication was transient psoas paresis (n=52). Most of these complications occurred in the early stages of learning. C-reactive protein normalization was delayed in seven patients (4.89%). The operation time showed a decreasing trend with the cases; however, EBL did not show any significant change. Notable operation-induced complications were cage malposition, vertebral body fracture, injury to the ureter, and injury to the lumbar vein. Conclusion :According to the learning curve, the operation time and psoas paresis decreased. It is important to select an appropriately sized cage along with clear dissection of the anterior border of the psoas muscle to prevent OLIF-specific complications.

Vertical split fracture of the vertebral body following oblique lumbar interbody fusion

“…Vertebral fractures during OLIF surgery are rare and usually the result of endplate injury. [9][10][11] However, similar to this case, vertebral fractures after OLIF without endplate injury have been barely reported. Some authors have reported vertebral fractures after extreme lateral interbody fusion or lateral lumbar interbody fusion applied large cages, but these were coronal plane fractures related to lateral screw fixation.…”

“…Vertebral fractures during OLIF surgery are rare and usually the result of endplate injury. [ 9 – 11 ]…”

Which factor can predict the effect of indirect decompression using oblique lumbar interbody fusion?

“…Owing to these advantages, OLIF can operate in beginners without difficulty. [ 10 ] However, various complications can occur in the OLIF, such as ureter injury, vessel injury, psoas paresis, respectively. [ 10 ]…”

“…[ 10 ] However, various complications can occur in the OLIF, such as ureter injury, vessel injury, psoas paresis, respectively. [ 10 ]…”

“…The major complications related to cage insertion were cage subsidence occurring 8 case, cage malposition 2case and vertebral body fracture 2case occurring. [ 10 ]…”