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

Abstract

Minimal invasive spinal fusion has become popular in the last decade. Oblique lumbar interbody fusion (OLIF) is a relatively new surgical technique and could avoid back muscle stripping and posterior complex destruction as in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Between December 2016 and September 2018, patients with single level degenerative spondylosis were selected to enroll in this retrospective study. A total of 21 patients that underwent OLIF and 41 patients that received MIS-TLIF were enrolled. OLIF showed significantly less blood loss and shorter surgery time compared to MIS-TLIF (p < 0.05). The improvement in segmental lordosis and coronal balance was significantly more in OLIF group than MIS-TLIF group (p < 0.05). When comparing with MIS-TLIF, OLIF was significantly better in Oswestry Disability Index (ODI) and visual analogue scale for back pain improvement at post-operative 6 months (p < 0.05). Both OLIF and MIS-TLIF are becoming mainstream procedures for lumbar degenerative-related disease, especially for spondylolisthesis. However, the indirect decompression of OLIF has shown to have less perioperative blood loss and shorter surgery time than that of MIS-TLIF. In addition, OLIF gives superior outcome in restoring segmental lordosis and coronal imbalance. While both OLIF and MIS-TLIF provide optimal clinical outcomes, upon comparison between the two techniques, the indirect decompression of OLIF seems to be a superior option in modern days.

Figure 1

A patient was diagnosed preoperatively with degenerative spondylolisthesis and lumbar spinal stenosis at L4-5 level, and underwent minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Radiographic images (A,B) and MRI (C) were taken preoperatively. The immediate post-operative lumbar spine lateral view (D) and lumbar antero-posterior view (E) are shown. Cage subsidence (black arrow) and screw halo sign (white arrow) were seen on the last follow-up images (F,G).

Figure 2

A patient was diagnosed with degenerative spondylolisthesis and lumbar spinal stenosis at L4-5 level, as shown on lumbar spine lateral view (A), lumbar antero-posterior view (B), and T2-weighted MR image (C). He received oblique lumbar interbody fusion (OLIF) at L4-L5 with lumbar spine lateral view (D) and lumbar antero-posterior view images (E) taken immediately after the surgery. Follow-up images (F,G) were taken at the last follow-up.

Figure 3

The lumbar spine lateral view image of a patient without any underlying disease was used to demonstrate how the segmental lordotic angle and disc height were measured. Segmental lordotic angle (SLA) is defined as the angle subtended by the superior endplate line of upper vertebral body and the lower endplate of lower vertebral body. Disc Height (DH) is defined as the distance from mid-position of upper endplate to lower endplate of two vertebral body.

Figure 4

The measurement of coronal tilting angle was assessed by measuring the Cobb angle of superior endplate line of upper vertebral body and the lower endplate of lower vertebral body on lumbar antero-posterior view image.