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Review
. 2023 Apr 3:14:100216.
doi: 10.1016/j.xnsj.2023.100216. eCollection 2023 Jun.

Comparing clinical and radiological outcomes between single-level OLIF and XLIF: A systematic review and meta-analysis

Arash Emami  1 , Neil Patel  1 , Daniel Coban  1 , Stephen Saela  1 , Kumar Sinha  1 , Michael Faloon  1 , Ki Soo Hwang  1
Affiliations
Review

Comparing clinical and radiological outcomes between single-level OLIF and XLIF: A systematic review and meta-analysis

Arash Emami et al. N Am Spine Soc J. .

Abstract

Background context: Oblique lumbar interbody fusion (OLIF) and extreme lateral interbody fusion (XLIF) are 2 popular minimally invasive spinal fusion techniques with unique approach-related complication profiles. Accordingly, patient-specific anatomical factors, such as vascular anatomy or iliac crest height, greatly influence which technique to use. Previous studies comparing these approaches do not account for the inability of XLIF to access the L5-S1 disc space and therefore do not exclude this level in their analysis. The purpose of this study was to compare radiological and clinical outcomes of these techniques in the L1-L5 region.

Methods: A query of 3 electronic databases (PubMed, CINAHL plus, and SCOPUS) was performed, without time restriction, to identify studies that evaluated outcomes of single-level OLIF and/or XLIF between L1 and L5. Based on heterogeneity, a random effects meta-analysis was performed to evaluate the pooled estimation of each variable between the groups. An overlap of 95% confidence intervals suggests no statistically significant difference at the p<.05 level.

Results: A total of 1,010 patients (408 OLIF, 602 XLIF) were included from 24 published studies. Improvements in disc height (OLIF: 4.2 mm; XLIF: 5.3 mm), lumbar segmental (OLIF: 2.3°; XLIF: 3.1°), and lumbar lordotic angles (OLIF: 5.3°; XLIF: 3.3°) showed no significant difference. The rate of neuropraxia was significantly greater in the XLIF group at 21.2% versus 10.9% in the OLIF group (p<.05). However, the rate of vascular injury was higher in the OLIF cohort at 3.2% (95% CI:1.7-6.0) as compared to 0.0 (95% CI: 0.0-1.4) in the XLIF cohort. Improvements in VAS-b (OLIF: 5.6; XLIF: 4.5) and ODI (OLIF: 37.9; XLIF: 25.6) scores were not significantly different between the 2 groups.

Conclusions: This meta-analysis demonstrates similar clinical and radiological outcomes between single-level OLIF and XLIF from L1 to L5. XLIF had significantly higher rates of neuropraxia, whereas OLIF had greater rates of vascular injury.

Keywords: Anterior to psoas; Lateral lumbar fusion; Lumbar spine; Meta-analysis; Minimally invasive; OLIF; Outcomes; Single-level; Transpsoas; XLIF.

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Conflict of interest statement

Dr. Emami receives grants/research support from NuVasive. Dr. Faloon receives grant and research support from Stryker Spine and Centinel Spine. Dr. Hwang is a consultant for Stryker Spine. None of these are applicable to the current study. For the remaining authors, none were declared.

Figures

Fig 1
Fig. 1
Flowchart of study selection. OLIF, oblique lumbar interbody fusion; XLIF, extreme lateral interbody fusion.
Fig 2
Fig. 2
A. Forest-plot demonstrating mean age, confidence intervals and heterogeneity present in the OLIF cohort. OLIF= oblique lumbar interbody fusion; CI= confidence interval. B. Forest-plot demonstrating mean age, confidence intervals and heterogeneity present in the XLIF cohort. XLIF= extreme lateral interbody fusion; CI= confidence interval.
Fig 3
Fig. 3
A. Forest-plot demonstrating mean BMI, confidence intervals and heterogeneity present in the OLIF cohort. OLIF= oblique lumbar interbody fusion; CI= confidence interval. B. Forest-plot demonstrating mean BMI, confidence intervals and heterogeneity present in the XLIF cohort. XLIF= extreme lateral interbody fusion; CI= confidence interval.
Fig 4
Fig. 4
A. Forest-plot demonstrating mean blood loss, confidence intervals and heterogeneity present in the OLIF cohort. OLIF= oblique lumbar interbody fusion; CI= confidence interval. B.Forest-plot demonstrating mean blood loss, confidence intervals and heterogeneity present in the XLIF cohort. XLIF= extreme lateral interbody fusion; CI= confidence interval.
Fig 5
Fig. 5
A. Forest-plot demonstrating mean operative time, confidence intervals and heterogeneity present in the OLIF cohort. OLIF= oblique lumbar interbody fusion; CI= confidence interval. B. Forest-plot demonstrating mean operative time, confidence intervals and heterogeneity present in the XLIF cohort. XLIF= extreme lateral interbody fusion; CI= confidence interval.
Fig 6
Fig. 6
A. Forest-plot demonstrating mean VAS-b score improvement, confidence intervals and heterogeneity present in the OLIF cohort. OLIF= oblique lumbar interbody fusion; CI= confidence interval; VAS-b= visual analogue scale for back pain scores. B. Forest-plot demonstrating mean VAS-b score improvement, confidence intervals and heterogeneity present in the XLIF cohort. XLIF= extreme lateral interbody fusion; CI= confidence interval; VAS-b= visual analogue scale for back pain scores.
Fig 7
Fig. 7
A. Forest-plot demonstrating mean ODI score improvement, confidence intervals and heterogeneity present in the OLIF cohort. OLIF= oblique lumbar interbody fusion; CI= confidence interval; ODI= oswestry disability index. B. Forest-plot demonstrating mean ODI score improvement, confidence intervals and heterogeneity present in the XLIF cohort. XLIF= extreme lateral interbody fusion; CI= confidence interval; ODI= oswestry disability index. B.
Fig 8
Fig. 8
A. Forest-plot demonstrating mean ADH improvement, confidence intervals and heterogeneity present in the OLIF cohort. OLIF= oblique lumbar interbody fusion; CI= confidence interval; ADH= anterior disc height. B. Forest-plot demonstrating mean ADH improvement, confidence intervals and heterogeneity present in the XLIF cohort. XLIF= extreme lateral interbody fusion; CI= confidence interval; ADH= anterior disc height.
Fig 9
Fig. 9
A. Forest-plot demonstrating mean LLA improvement, confidence intervals and heterogeneity present OLIF cohort. OLIF= oblique lumbar interbody fusion; CI= confidence interval; LLA= lumbar lordosis angle. B. Forest-plot demonstrating mean LLA improvement, confidence intervals and heterogeneity present in the XLIF cohort. XLIF= extreme lateral interbody fusion; CI= confidence interval; LLA= lumbar lordosis angle.
Fig 10
Fig. 10
A. Forest-plot demonstrating mean LSA improvement, confidence intervals and heterogeneity present in OLIF cohort. OLIF= oblique lumbar interbody fusion; CI= confidence interval; LSA= lumbar segmental angle. B. Forest-plot demonstrating mean LSA improvement, confidence intervals and heterogeneity present in the XLIF cohort. XLIF= extreme lateral interbody fusion; CI= confidence interval; LSA= lumbar segmental angle.
Fig 11
Fig. 11
Funnel plot evaluating publication bias related to mean difference in ADH. ADH, anterior disc height.
Fig 12
Fig. 12
Funnel plot evaluating publication bias related to mean difference in LLA. LLA, lumbar lordosis angle.
Fig 13
Fig. 13
Funnel plot evaluating publication bias related to mean difference in ODI scores. ODI, oswestry disability index.
Fig 14
Fig. 14
Funnel plot evaluating publication bias related to mean difference in VAS scores. VAS, visual analog scale.
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