The Radiologic and Clinical Outcomes of Oblique Lateral Interbody Fusion for Correction of Adult Degenerative Lumbar Deformity

Abstract

Background: Osteotomies aimed at correcting adult spinal deformity are associated with higher complications and perioperative morbidity. Recently, oblique lumbar interbody fusion (OLIF) was introduced for degenerative lumbar diseases. The aim of our study is to demonstrate the effectiveness of OLIF on the management of adult degenerative lumbar deformity (ADLD). Materials and Methods: Patients with ADLD who underwent deformity correction and decompression using OLIF and posterior instrumentation were enrolled. For radiologic evaluation, Cobb's angle (CA), sagittal vertical axis (SVA), lumbar lordosis (LL), thoracic kyphosis (TK), pelvic tilt (PT), sacral slope (SS), and pelvic incidence (PI) were evaluated. Visual analog scale (VAS), Oswestry disability index (ODI), and perioperative parameters were recorded for clinical evaluation. Results: Fifteen patients with a mean age of 67 years (63–74 years) were enrolled prospectively and an average of 3 OLIFs (range 1–4) was performed. Posterior instrumentations were done at average of six levels (range 4–8). The mean operative blood loss was 863 ml (range 500–1400 ml) with a mean surgical duration of 7 h (range 3–11 h). SVA, TK, LL, CA, PT, and SS showed significant correction ( P < 0.05) in immediate postoperative period and all parameters except TK were maintained at final followup. At the end of 24 months of average followup, 86% (13/15) showed fusion. VAS (leg pain), VAS (back pain), and ODI improved by 74% (range 40–100), 58% (range 20%–80%), and 69.5% (range 4%–90%), respectively. There were two major complications requiring revision (1 infection and 1 adjacent vertebral body fracture). Transient hip weakness present in two patients (13%) recovered within 6 weeks. Conclusions: OLIF gives favorable short term clinical and radiological outcomes in patients of ADLD. It could potentially reduce the need for morbid pelvic fixation and posterior osteotomies in patients with degenerative lumbar deformity.

Oblique lateral interbody fusion combined with different internal fixations for the treatment of degenerative lumbar spine disease: a finite element analysis

“…However, the difficulty of removing lateral recess, ligament flava hypertrophy, and hyperostosis of facet joints directly from the lateral corridor renders OLIF challenging. [ 34 , 35 ] The improvement of symptoms after OLIF is based on the restoration of disc height, the increase of the foraminal area, the correction of coronal balance, and the indirect decompression of the neural elements by the wider implants [ 6 , 36 ]. Joseph et al [ 37 ] reported a complication rate of 20.2% (380/1885) after TLIF for nerve injury, while Abe et al [ 13 ] reported a complication rate of 1.2% (2/155) after OLIF, suggesting that the complication rate of OLIF for nerve injury is significantly lower.…”

“…Different fixation methods have been reported in the literature, including CAGE alone without other internal fixation devices, such as SA, UPS, and BPS. Relatively little has been reported on CBT with UPS-CTFS [ 36 ], and to the best of our knowledge, few studies have used FE analysis methods to analyse the biomechanical stability of OLIF with different fixation options.…”

Comparison of outcomes between indirect decompression of oblique lumbar interbody fusion and MIS-TLIF in one single-level lumbar spondylosis

“…Some studies have shown that coronal tilting angle can be corrected by oblique lumbar interbody fusion technique. In a study by Patel et al, 15 patients underwent OLIF and radiologic evaluation was done 31 . Cobb’s angle, lumbar lordosis, sagittal vertical axis, thoracic kyphosis, sacral slope, pelvic tilt, and pelvic incidence all showed significant correction immediately after the procedure.…”

Outcomes of Oblique Lateral Interbody Fusion for Adult Spinal Deformity: A Systematic Review and Meta-Analysis

“…To investigate the source of the heterogeneity, a subgroup analysis was performed according to whether there is thoracic PCO. The results of 3 studies 15 , 21 , 27 which did not include thoracic PCO showed that the average correction of TK is -9.36° (95%CI, -12.13° to -6.60°). A study 24 involving thoracic PCO showed that the average correction of TK is -31.30° (95%CI, -38.64° to -23.96°).…”