Abstract and Introduction
Study Design: Prospective cohort study.
Objective: To assess the differences in the clinical and radiological outcomes between oblique lateral interbody fusion (OLIF) and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF).
Summary of Background Data: Nowadays, there is still a controversy regarding whether OLIF is superior to MI-TLIF in the management of degenerative lumbar disease.
Methods: Between August 3, 2019 and February 3, 2020, 137 patients were assigned to OLIF or MI-TLIF at their request and the surgeon's discretion: 71 in the OLIF group and 66 in the MI-TLIF group. The perioperative data, patient-reported outcomes, radiographic outcomes, and complications were compared between the two groups.
Results: The OLIF group showed shorter operation time (110.5 vs.183.8 minutes, P < 0.001), lesser estimated blood loss (123.1 vs. 232.0 mL, P < 0.001), shorter length of hospital stay (5.5 vs. 6.7 days, P < 0.001), and lower serum creatine kinase (CK) (1 day postoperatively) (376.0 vs. 541.8 IU/L, P < 0.01) than that of MI-TLIF group. Both groups showed no significant differences in the visual analog scale (VAS) scores of lower back and leg pain and the Oswestry Disability Index (ODI) scores preoperatively and at 1, 3, and 12 months postoperatively, respectively (P > 0.05). Compared with the MI-TLIF group, the OLIF group showed better restoration of disc height (DH) (4.7/4.6/4.7 vs. 3.7/3.7/3.7 mm, P < 0.01) and lumbar lordosis angle (LLA) (10.5°/10.8°/11.1° vs. 5.8°/5.7°/5.3°, P < 0.001), but not the value of segmental lordosis angle (SLA) (P > 0.05) at 1 day, 1 month, and 1 year postoperatively, respectively. The complication rate of OLIF was higher than that of MI-TLIF (29.4% vs. 9.7%, P < 0.01).
Conclusion: Compared with MI-TLIF, OLIF showed similar results in terms of patient-reported outcomes, restoration of SLA and fusion rate, and superior results with respect to restoration of DH and LLA, operation time, estimated blood loss, length of hospital stay, and serum CK levels (1 day postoperatively). Even though the complication rate of OLIF is higher than that of MI-TLIF, it does not bring persistent and substantial damage to the patients.
Level of Evidence: 3
Conventional posterior/transforaminal lumbar interbody fusion (TLIF) and anterior lumbar interbody fusion techniques have yielded satisfactory clinical outcomes for degenerative lumbar diseases.[1,2] However, iatrogenic paraspinal muscle injury, posterior tension band disruption, and approach-related complications are a concern.[2,3] Thus, surgical approaches, including direct lateral interbody fusion, extreme lateral interbody fusion, and oblique lateral interbody fusion (OLIF) have been popularized, and minimally invasive (MI) procedures are adopted, alongside mini-open techniques and unilateral or bilateral Wiltse procedures.
The efficacy of OLIF and MI-TLIF for the management of degenerative lumbar disease has been demonstrated in several studies.[6–8] However, based on the English literature,[9–13] it is difficult to draw a conclusion regarding whether OLIF is superior to MI-TLIF because of small sample sizes, heterogeneity of study objectives and evaluation indices, and a low level of evidence. Therefore, we aimed to assess the clinical and radiological outcomes of OLIF and MI-TLIF. We suppose that OLIF provides better clinical and radiological outcomes compared with MI-TLIF.
Spine. 2022;47(6):E233-E242. © 2022 Lippincott Williams & Wilkins