Efficacy and radiographic analysis of oblique lumbar interbody fusion in treating adult spinal deformity

Abstract

Adult spinal deformity (ASD) is usually rigid and requires a combined anterior-posterior approach for deformity correction. Anterior lumbar interbody fusion (ALIF) allows direct access to the disc space and placement of a large interbody graft. A larger interbody graft facilitates correction of ASD. However, an anterior approach carries significant risks. Lateral lumbar interbody fusion (LLIF) through a minimally invasive approach has recently been used for ASD. The present study was performed to evaluate the effectiveness of oblique lumbar interbody fusion (OLIF) in the treatment of ASD. We performed a retrospective study utilizing the data of 74 patients with ASD. The inclusion criteria were lumbar coronal Cobb angle > 20°, pelvic incidence (PI)-lumbar lordosis (LL) mismatch > 10°, and minimum follow-up of 2 years. Patients were divided into two groups: ALIF combined with posterior spinal fixation (ALIF+PSF) (n = 38) and OLIF combined with posterior spinal fixation (OLIF+PSF) (n = 36). The perioperative spinal deformity radiographic parameters, complications, and health-related quality of life (HRQoL) outcomes were assessed and compared between the two groups. The preoperative sagittal vertical axis (SVA), LL, PI-LL mismatch, and lumbar Cobb angles were similar between the two groups. Patients in the OLIF+PSF group had a slightly higher mean number of interbody fusion levels than those in the ALIF+PSF group. At the final follow-up, all radiographic parameters and HRQoL scores were similar between the two groups. However, the rates of perioperative complications were higher in the ALIF+PSF than OLIF+PSF group. The ALIF+PSF and OLIF+PSF groups showed similar radiographic and HRQoL outcomes. These observations suggest that OLIF is a safe and reliable surgical treatment option for ASD.

Fig 1

(A, B) Anteroposterior (AP) and lateral standing radiographs of a 65–year–old woman with severe back pain and pain in both legs, showing degenerative lumbar kyphoscoliosis. A three–step (posterior–anterior–posterior) approach was used to obtain adequate sagittal and coronal balance. (C, D) Postoperative AP and lateral radiographs showed L3–S1 interbody fusion and good sagittal alignment.

Fig 2

(A, B) Anteroposterior (AP) and lateral standing radiographs of a 70–year–old woman who had severe back pain and pain in both legs, showing degenerative lumbar kyphoscoliosis. A three–step (posterior–oblique–posterior) approach was used to obtain adequate sagittal and coronal balance. (C, D) Postoperative AP and lateral radiographs showed L1–5 interbody fusion and good sagittal alignment.