Comparing stand-alone oblique lumbar interbody fusion with posterior lumbar interbody fusion for revision of rostral adjacent segment disease

Abstract

Spinal fusion has become a standard treatment for symptomatic intervertebral degenerative disc disease. The present study aimed to compare perioperative parameters, clinical outcomes, and radiographic results of stand-alone oblique lumbar interbody fusion (OLIF) with posterior lumbar interbody fusion (PLIF) for the revision of rostral adjacent segment disease (ASD) following prior posterior lumbar fusion.Thirty-six patients who underwent revision surgeries for rostral ASD were retrospectively reviewed. Among them, 17 patients underwent stand-alone OLIF (OLIF group) and 19 patients underwent PLIF (PLIF group). The length of operation, intraoperative hemorrhage, bed rest duration, and length of hospital stay were compared between the 2 groups. Clinical results were evaluated with the Oswestry Disability Index (ODI) and visual analog scale (VAS). Radiological results were evaluated with disc height (DH), foraminal height (FH), retrolisthesis index (RI), and lumbar lordosis (LL), as well as the fusion rate and cage subsidence. Follow-up results at 1 week, 3 months, and 12 months postoperatively were compared between the 2 groups.The OLIF group had less intraoperative blood loss, shorter operative time, bed rest time, and hospital stay than did the PLIF group (P < .05). The OLIF group had lower VAS scores for back pain than the PLIF group at 1 week and 3 months postoperatively (P < .05), and lower VAS scores for leg pain than the PLIF group at 1 week postoperatively (P < .05). The OLIF group had lower ODI than the PLIF group at 1 week and 3 months postoperatively (P < .05). No significant differences were found in DH and FH between the 2 groups preoperatively (P > .05); the OLIF group showed higher DH and FH than the PLIF group at all time points (P < .05). No significant differences were found in RI and LL between the 2 groups at any time point. All patients achieved fusion at 12 months postoperatively, and cage subsidence was not observed in either group.OLIF is effective and safe for the treatment of rostral ASD following prior posterior lumbar fusion, and is superior to PLIF in terms of perioperative parameters, short-term clinical outcomes, and DH restoration, with similar fusion and reduction rates.

Differences in radiographic and clinical outcomes of oblique lateral interbody fusion and lateral lumbar interbody fusion for degenerative lumbar disease: a meta-analysis

“…Pooled analysis of nine studies treated with OLIF [3, 8–11, 14, 16, 21, 22] showed that the pooled mean of ODIs varies across studies (I 2 = 94.8%), and the pooled SMD was − 3.06 (95% CI, − 4.03 to − 2.08). Pooled analysis of eighteen studies treated with LLIF [5, 10, 26, 27, 30, 33, 34, 36–38, 46, 48, 49, 51–54, 57] showed that the pooled mean of ODIs varies across studies (I 2 = 83.9%), and the pooled SMD was − 1.76 (95% CI, − 2.08 to − 1.43) (Fig.…”

“…Operative blood loss, operative time, and length of hospital stay have been reported in eleven studies of OLIF [2, 8–11, 16, 17, 21, 23–25] including 787 patients. OLIF combined with posterior fixation resulted in an average blood loss of 136 mL (49.7 for 1 operated level; 112.5 for 2 operated levels, 148.7 for 3 operated levels or more), an average operative time of 114 min (54.5 for 1 operated level; 67.2 for 2 operated levels, 119.5 for 3 operated levels or more), and an average length of hospital stay of 6.8 d (5.1 for 1 operated level; 6.4 for 2 operated levels, 7.9 for 3 operated levels or more) [58].…”

“…OLIF combined with posterior fixation resulted in an average blood loss of 136 mL (49.7 for 1 operated level; 112.5 for 2 operated levels, 148.7 for 3 operated levels or more), an average operative time of 114 min (54.5 for 1 operated level; 67.2 for 2 operated levels, 119.5 for 3 operated levels or more), and an average length of hospital stay of 6.8 d (5.1 for 1 operated level; 6.4 for 2 operated levels, 7.9 for 3 operated levels or more) [58]. OLIF stand-alone [8, 11] resulted in an average operative blood loss of 83 mL, an average operative time of 104.2 min, and an average length of hospital stay of 6 d. Operative blood loss, operative time, and length of hospital stay have been reported in 29 studies of LLIF [6, 10, 26–32, 34, 35, 37–42, 44–46, 49, 51, 52, 54–57] including 1698 patients. LLIF combined with posterior fixation resulted in an average operative blood loss of 176 mL (71.6 for 1 operated level; 115 for 2 operated levels, 176 for 3 operated levels or more), an average operative time of 188 min (134.8 for 1 operated level; 174 for 2 operated levels, 253 for 3 operated levels or more), and an average length of hospital stay of 5.9 d (2 for 1 operated level; 3 for 2 operated levels, 4 for 3 operated levels or more).…”

Development and Application of Oblique Lumbar Interbody Fusion

“…It is preliminarily confirmed that the revision operation can be used as an indication for OLIF. Zhu et al . followed up 17 patients with OLIF and 19 patients with PLIF.…”

Adjacent Segment Infection after Lumbar Fusion: A Case Report and the Literature Review

“…Various spinal fusion techniques have been reported, and both anterior and posterior approaches were able to achieve excellent long-term outcomes [6,7]. In the future, we may choose the oblique lumbar intervertebral fusion (OLIF) for debridement and intervertebral fusion just like its use in the revision surgery of ASD [13]. The initial instrument was not recommended to be removed unless the screws were loose or connected to the infective space [14].…”