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. 2023 Mar 2;18(1):158.
doi: 10.1186/s13018-023-03652-5.

Comparison of radiographic and clinical outcomes between ALIF, OLIF, and TLIF over 2-year follow-up: a comparative study

Kuan-Kai Tung  1 , Wei-Cheng Tseng  1 , Yun-Che Wu  1 , Kun-Hui Chen  1   2   3   4 , Chien-Chou Pan  1   5 , Wen-Xian Lu  6 , Cheng-Min Shih  1   7 , Cheng-Hung Lee  8   9   10
Affiliations

Comparison of radiographic and clinical outcomes between ALIF, OLIF, and TLIF over 2-year follow-up: a comparative study

Kuan-Kai Tung et al. J Orthop Surg Res. .

Abstract

Background: Regarding the increasing adoption of oblique lateral interbody fusion (OLIF) for treating degenerative lumbar disorders, we aimed to evaluate whether OLIF, one of the options for anterolateral approach lumbar interbody fusion, demonstrate clinical superiority over anterior lumbar interbody fusion (ALIF) or posterior approach, represented by transforaminal lumbar interbody fusion (TLIF).

Methods: Patients who received ALIF, OLIF, and TLIF for symptomatic degenerative lumbar disorders during the period 2017-2019 were identified. Radiographic, perioperative, and clinical outcomes were recorded and compared during 2-year follow-up.

Results: A total of 348 patients with 501 correction levels were enrolled in the study. Fundamental sagittal alignment profiles were substantially improved at 2-year follow-up, particularly in the anterolateral approach (A/OLIF) group. The Oswestry disability index (ODI) and EuroQol-5 dimension (EQ-5D) in the ALIF group were superior when compared to the OLIF and TLIF group 2-year following surgery. However, comparisons of VAS-Total, VAS-Back, and VAS-Leg revealed no statistically significance across all approaches. TLIF demonstrated highest subsidence rate of 16%, while OLIF had least blood loss and was suitable for high body mass index patients.

Conclusions: Regarding treatment for degenerative lumbar disorders, ALIF of anterolateral approach demonstrated superb alignment correction and clinical outcome. Comparing to TLIF, OLIF possessed advantage in reducing blood loss, restoring sagittal profiles and the accessibility at all lumbar level while simultaneously achieving comparable clinical improvement. Patient selection in accordance with baseline conditions, and surgeon preference both remain crucial issues circumventing surgical approach strategy.

Keywords: ALIF; Clinical outcome; Degenerative spine disorders; Lumbar interbody fusion; OLIF; TLIF.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Fig. 1
Fig. 1
Grading for fusion status. Arrow ( →), interbody cage in position. Asterisk (*), the subsidence of LIF cage. Noted that cage subsidence can be observed in different fusion status
Fig. 2
Fig. 2
Numbers of patients who were screened and included in the study. ALIF Anterior lumbar interbody fusion; OLIF Oblique lumbar interbody fusion; TLIF Transforaminal lumbar interbody fusion
Fig. 3
Fig. 3
Comparison of clinical outcome between ALIF, OLIF, and TLIF over 2 years. a ODI b EQ-5D c VAS-Total d VAS-Back e VAS-Leg. ALIF Anterior lumbar interbody fusion; OLIF Oblique lumbar interbody fusion; TLIF Transforaminal lumbar interbody fusion; ODI Oswestry disability index; EQ-5D EuroQol-5-dimension score; VAS-Total VAS of Pain in Total; VAS-Leg VAS of pain in leg; VAS-Back VAS of pain in back
Fig. 4
Fig. 4
Comparison of clinical outcome between anterolateral and posterior approach over 2 years. a ODI b EQ-5D c VAS-Total d VAS-Back e VAS-Leg. ALIF Anterior lumbar interbody fusion; OLIF Oblique lumbar interbody fusion; TLIF Transforaminal lumbar interbody fusion; ODI Oswestry disability index; EQ-5D EuroQol-5-dimension score; VAS-Total VAS of pain in total; VAS-Leg VAS of pain in leg; VAS-Back VAS of pain in back
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