Comparison of Oblique Lateral Interbody Fusion (OLIF) and Minimally Invasive Transforaminal Lumbar Interbody Fusion (MI-TLIF) for Treatment of Lumbar Degeneration Disease

A Prospective Cohort Study

Hai-Feng Zhu, MM; Xiang-Qian Fang, MD; Feng-Dong Zhao, MD; Jian-Feng Zhang, MD; Xing Zhao, MD; Zhi-Jun Hu, MD; Shun-Wu Fan, MD

Disclosures

Spine. 2022;47(6):E233-E242. 

In This Article

Results

No significant differences in patients' demographic and clinical characteristics were noted between the two groups (P > 0.05, Table 1). The loss rates for the two groups were comparable after 12-month follow-up (OLIF: 4.2% [3/71] vs. MI-TLIF: 6.1% [4/66], P = 0.626, χ 2 = 0.238).

Perioperative Data

The perioperative data are shown in Table 1. Compared with MI-TLIF, OLIF demonstrated shorter operation time (110.5 ± 37.8 vs. 183.8 ± 65.5 minutes, P < 0.001), lesser estimated blood loss (123.1 ± 39.8 vs. 232.0 ± 83.2 mL, P < 0.001), and shorter length of hospital stay (5.5 ± 1.1 vs. 6.7 ± 2.0 days, P < 0.001). Serum CK level in the OLIF group was markedly lower than that in the MI-TLIF group 1 day postoperatively (376.0 ± 140.8 vs. 541.8 ± 400.0 IU/L, P < 0.01), but not preoperatively and 3 days postoperatively (P > 0.05) (Table 1).

Patient-reported Outcomes

The OLIF and MI-TLIF groups showed no significant differences in the VAS scores for lower back (6.7 ± 1.6/1.3 ± 0.9/1.0 ± 0.8/1.1 ± 0.8 vs. 6.4 ± 1.3/1.5 ± 0.9/1.2 ± 0.8/1.3 ± 0.6, P > 0.05), leg pain (5.6 ± 2.0/1.3 ± 0.9/1.0 ± 0.7/0.7 ± 0.5 vs. 5.5 ± 2.5/1.2 ± 0.9/0.9 ± 0.7/0.8 ± 0.7, P > 0.05), and in the ODI scores (61.5 ± 10.3/6.4 ± 4.3/4.8 ± 3.5/4.5 ± 3.5% vs. 58.6 ± 11.0/7.5 ± 4.1/5.4 ± 3.8/5.1 ± 3.5%, P > 0.05) recorded preoperatively and 1, 3, and 12 months postoperatively, respectively (Figure 3) (Supplemental Digital Content 3, https://links.lww.com/BRS/B843).

Figure 3.

Comparison of VAS score of lower back and leg pain and ODI score between the OLIF and MI-TLIF groups preoperatively (pre), 1 month (1 M), 3 months (3 M), 12 months (12 M) postoperatively. Data represents mean ± SD. Note: ns: the difference was not significant (P > 0.05). MI-TLIF indicates minimally invasive transforaminal lumbar interbody fusion; ODI, Oswestry Disability Index; OLIF, oblique lateral interbody fusion; VAS, visual analog scale.

Complications

Major complications are shown in Figure 4 and all accepted immediate and effective treatments, listed in Table 2. The complication rate was significantly higher in the OLIF group than in the MI-TLIF group (29.4% [20/68] vs. 9.7% [6/62], P < 0.01, χ[2] = 4.20).

Figure 4.

Comparison of perioperative and postoperative complications of OLIF and MI-TLIF. MI-TLIF indicates minimally invasive transforaminal lumbar interbody fusion; OLIF, oblique lateral interbody fusion.

Radiographic Outcomes

The interobserver and intraobserver ICC for DH, SLA, and LLA restoration and fusion rate were between 0.85 and 0.95.

The OLIF group had significantly better DH and LLA restoration than the MI-TLIF group at 1 day, 1 month, and 12 months postoperatively (4.7 ± 2.1/4.6 ± 2.1/4.7 ± 2.0 vs. 3.7 ± 2.0/3.7 ± 2.0/3.7 ± 1.9 mm, P < 0.01; 10.5 ± 7.7°/10.8 ± 7.3°/11.1 ± 6.5° vs. 5.8 ± 4.5°/5.7 ± 3.3°/5.7 ± 3.3°, P < 0.001, respectively), but not for SLA restoration (5.2 ± 2.4°/5.1 ± 2.7°/5.2 ± 2.6° vs. 4.4 ± 2.4°/4.4 ± 2.2°/4.5 ± 2.1°, P > 0.05) (Figure 5) (Supplemental Digital Content 4, https://links.lww.com/BRS/B844). At the latest follow-up, a high fusion rate comparable to that of MI-TLIF group (98.4%, 61/62) was noted for the OLIF group (98.4% [61/62] vs. 98.5% [67/68], P = 0.614) (Supplemental Digital Content 4, https://links.lww.com/BRS/B844). Representative cases are shown in Figure 6A–L.

Figure 5.

Comparison of DH, SLA, and LLA restoration between the OLIF and MI-TLIF groups 1 day (1D), 1 month (1 M), and 12 months (12 M) postoperatively. Data represents mean ± SD. Note: ns: the difference was not significant (P > 0.05); ** and ***: the difference was significant (P < 0.01 and P < 0.001 respectively). DH indicates disc height; LLA, lumbar lordosis angle; MI-TLIF, minimally invasive transforaminal lumbar interbody fusion; OLIF, oblique lateral interbody fusion; SLA, segmental lordosis angle.

Figure 6.

Representative cases in respect to DH, SLA, and LLA restoration in OLIF (ABCD) and MI-TLIF (EFGH) groups before operation and at 1 day, 1 month, and 12 months postoperatively, and successful lumbar fusion in OLIF(IJ) and MI-TLIF(KL) groups at 12 months postoperatively. DH indicates disc height; LLA, lumbar lordosis angle; MI-TLIF, minimally invasive transforaminal lumbar interbody fusion; OLIF, oblique lateral interbody fusion; SLA, segmental lordosis angle.

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