Tag: Oblique lumbar interbody fusion

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Comprehensive analysis of biomechanical stability and clinical efficacy in oblique lumbar interbody fusion with distinct anterolateral fixation modalities

J Neurosurg Spine 44:436–448, 2026

This study evaluates how different anterolateral screw angles in oblique lumbar interbody fusion with anterolateral fixation (OLIF-AF) affect cage subsidence, biomechanical stability, and clinical outcomes. A retrospective cohort of 80 L4–5 OLIF-AF patients was grouped by coronal and horizontal screw angles, supplemented by finite element models simulating four screw configurations under physiological loads.

Findings show coronal-plane parallel screw placement reduced cage subsidence, cage stress, displacement, and range of motion versus nonparallel placement, while horizontal bifurcation had no significant effect on subsidence; clinical scores and fusion rates were similar across groups. The authors recommend coronal parallelism with bicortical purchase to optimize stability and lower subsidence risk.

Coronal Plane Parallel Screw Placement: Parallel screw placement in the coronal plane during OLIF-AF significantly reduces the risk of cage subsidence (CS) and enhances biomechanical stability compared to nonparallel placement.

Nonparallel Coronal Screw Placement Risks: Nonparallel coronal screw placement (G2 and G3 groups) is independently associated with higher CS rates, greater reduction in disc height (ΔDH), increased cage stress, displacement, and range of motion (ROM), indicating poorer biomechanical outcomes.

Horizontal Screw Bifurcation: Horizontal screw bifurcation (difference in horizontal plane angle) does not have a statistically significant impact on CS risk or clinical outcomes when coronal plane parallelism is maintained.

Bicortical Purchase Importance: Ensuring that screws penetrate the contralateral vertebral cortex (bicortical purchase) may further reduce the risk of CS, while lack of penetration is associated with earlier and more severe subsidence.

Clinical Outcomes: No significant differences in pain relief (VAS-LBP, VAS-LP) or Oswestry Disability Index (ODI) were observed among the four screw configuration groups at any follow-up point; fusion rates were also similar.

Finite Element Analysis Validation: Finite element modeling confirmed that nonparallel screw configurations increase cage stress and spinal ligament tension, especially during flexion, supporting clinical findings.

Risk Factors for Subsidence: Lower bone mineral density (BMD) and nonparallel coronal screw placement are independent risk factors for cage subsidence after OLIF-AF.

Surgical Recommendation: For optimal biomechanical stability and reduced complication risk, OLIF-AF screws should be placed parallel to the coronal plane and close to the endplates, with bicortical purchase, as this configuration provides better load sharing and fusion environment.

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Sarcopenia Predicts Early Adjacent Segment Disease Development After Anterior and Oblique Lumbar Interbody Fusion

Operative Neurosurgery 29:667–677, 2025

his clinical study evaluates whether sarcopenia, measured by psoas-to-vertebral body morphometrics on preoperative MRI, predicts early adjacent segment disease (ASD) within three years after anterior or oblique lumbar interbody fusion (ALIF/OLIF). Retrospective analysis of 104 patients found sarcopenia strongly associated with ASD, with sarcopenic patients showing markedly higher ASD rates and greater muscle fat infiltration.

The paper reports that psoas area, P:VBR ratios, and age remained significant predictors on multivariate analysis, while spinopelvic parameters lost significance after adjustment. The authors propose routine preoperative morphometric screening to guide surgical planning, risk counseling, and targeted perioperative optimization for high-risk patients.

• Sarcopenia: Preoperative sarcopenia, defined by reduced psoas muscle area relative to vertebral body area, is a strong independent predictor of early adjacent segment disease (ASD) within 3 years after anterior or oblique lumbar interbody fusion (ALIF/OLIF) ().

• ASD Incidence: 24% of patients developed ASD within 3 years post-ALIF/OLIF; 84.21% of sarcopenic patients developed ASD compared to 10.59% of nonsarcopenic patients.

• Morphometric Assessment: Psoas:vertebral body ratio (P:VBR) at L4 on preoperative MRI provides a simple, objective screening tool for sarcopenia and ASD risk stratification.

• Spinopelvic Parameters: Postoperative pelvic tilt (PT) and pelvic incidence-lumbar lordosis (PI-LL) mismatch were associated with ASD in univariate analysis, but not after multivariate adjustment; sarcopenia remained the strongest predictor.

• Other Risk Factors: Older age, higher preoperative disability (ODI), more instrumented/interbody levels, and prior lumbar surgery also increased ASD risk, while gender, BMI, and comorbidities did not.

• Instrumentation vs. Stand-alone Cages: Patients with stand-alone ALIF/OLIF (no posterior instrumentation) had lower rates of ASD, possibly due to less mechanical stress on adjacent segments.

• Clinical Implications: Identifying sarcopenia preoperatively can inform surgical planning, patient counseling, and may guide targeted pre- and postoperative interventions to improve outcome.

• Future Directions: Further research is needed to determine if interventions like resistance training or dietary modification can reduce ASD risk in sarcopenic patients, and to establish standardized diagnostic criteria for sarcopenia in spine surgery.

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Oblique lumbar interbody fusion combined with stress end plate augmentation and anterolateral screw fixation for degenerative lumbar spinal stenosis with osteoporosis

The Spine Journal 23 (2023) 523−532

Oblique lumbar interbody fusion (OLIF) has been proven to be effective in treating degenerative lumbar spinal stenosis (DLSS). Whether OLIF is suitable for treating patients with DLSS with osteoporosis (OP) is still controversial. Bone cement augmentation is widely used to enhance the internal fixation strength of osteoporotic spines. However, the effectiveness of OLIF combined with bone cement stress end plate augmentation (SEA) and anterolateral screw fixation (AF) for DLSS with OP have not confirmed yet.

PURPOSE: To evaluate the clinical, radiological, and functional outcomes of OLIF-AF versus OLIF-AF-SEA in the treatment of DLSS with OP.

STUDY DESIGN: Retrospective case-control study.

PATIENT SAMPLE: A total of 60 patients with OP managed for DLSS at L4−L5.

OUTCOME MEASURES: Visual analog scale (VAS) score of the lower back and leg, Oswestry Disability Index (ODI), disk height (DH), lumbar lordosis (LL), segmental lordosis (SL), cage subsidence and fusion rate.

METHODS: The study was performed as a retrospective matched-pair case‒controlled study. Patients with OP managed for DLSS at L4−L5 between October 2017 and June 2020 and completed at least 2 years of follow-up were included, which were 30 patients treated by OLIF-AF and 30 patients undergoing OLIF-AF-SEA. The demographics and radiographic data, fusion status and functional outcomes were therefore compared to evaluate the efficacy of the two approaches.

RESULTS: Pain and disability improved similarly in both groups at the 24-month follow-up. However, the SEA group had lower pain and functional disability at 3 months postoperatively (p<.05). The mean postoperative disc height decrease (4DH) was significantly lower in the SEA group than in the control group (1.17§0.81 mm vs 2.89§2.03 mm; p<.001). There was no significant difference in lumbar lordosis (LL) or segmental lordosis (SL) between the groups preoperatively and 1 day postoperatively. However, a statistically significant difference was observed in SL and LL between the groups at 24 months postoperatively (p<.05). CS was observed in 4 cases (13.33%) in the SEA group and 17 cases (56.67%) in the control group (p<.001). A nonsignificant difference was observed in the fusion rate between the SEA and control groups (p=.347) at 24 months postoperatively.

CONCLUSIONS: This study revealed that OLIF-AF-SEA was safe and effective in the treatment of DLSS with OP. Compared with OLIF-AF, OLIF-AF-SEA results in a minor postoperative disc height decrease, a lower rate of CS, better sagittal balance, and no adverse effect on interbody fusion.

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OLIF versus ALIF: Which is the better surgical approach for degenerative lumbar disease?

European Spine Journal (2023) 32:689–699

The aim of this study was to compare the clinical and radiographical outcomes between OLIF and ALIF in treating lumbar degenerative diseases.

Methods We searched PubMed, Embase, Web of Science, and Cochrane Library for relevant studies. Changes in disc height (DH), segmental lordosis angle (SLA), lumbar lordosis (LL), visual analogue scale (VAS) score, and Oswestry disability index (ODI) between baseline and final follow-up, along with other important surgical outcomes, were assessed and analysed. Data on the global fusion rate and main complications were collected and compared.

Results Approximately, 2041 patients from 36 studies were included, consisting of 1057 patients who underwent OLIF and 984 patients who underwent ALIF. The results reveal no significant difference in DH, SLA, VAS score, and ODI between the two groups (all P > 0.05). The operation time, estimated blood loss, and length of hospital stay were also comparable between the two groups. Over 90% of the fusion rate was achieved in both groups. The OLIF group showed a higher complication rate than the ALIF group (OLIF 18.83% vs ALIF 7.32%).

Conclusions OLIF leads to a higher complication rate, with the most notable complication being cage subsidence. Both OLIF and ALIF are effective treatments for degenerative lumbar diseases and have similar therapeutic effects. ALIF was expected to be more expensive for patients because of the necessity of involving vascular surgeons.

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Assessing the differences in operative and patient-reported outcomes between lateral approaches for lumbar fusion: a systematic review and indirect meta-analysis

 

J Neurosurg Spine 37:498–514, 2022

Anterior-to-psoas lumbar interbody fusion (ATP-LIF), more commonly referred to as oblique lateral interbody fusion, and lateral transpsoas lumbar interbody fusion (LTP-LIF), also known as extreme lateral interbody fusion, are the two commonly used lateral approaches for performing a lumbar fusion procedure. These approaches help overcome some of the technical challenges associated with traditional approaches for lumbar fusion. In this systematic review and indirect meta-analysis, the authors compared operative and patient-reported outcomes between these two select approaches using available studies.

METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach, the authors conducted an electronic search using the PubMed, EMBASE, and Scopus databases for studies published before May 1, 2019. Indirect meta-analysis was conducted on fusion rate, cage movement (subsidence plus migration), permanent deficits, and transient deficits; results were depicted as forest plots of proportions (effect size [ES]).

RESULTS A total of 63 studies were included in this review after applying the exclusion criteria, of which 26 studies investigated the outcomes of ATP-LIF, while 37 studied the outcomes of LTP-LIF. The average fusion rate was found to be similar between the two groups (ES 0.97, 95% CI 0.84–1.00 vs ES 0.94, 95% CI 0.91–0.97; p = 0.561). The mean incidence of cage movement was significantly higher in the ATP-LIF group compared with the LTP-LIF group (stand-alone: ES 0.15, 95% CI 0.06–0.27 vs ES 0.09, 95% CI 0.04–0.16 [p = 0.317]; combined: ES 0.18, 95% CI 0.07–0.32 vs ES 0.02, 95% CI 0.00–0.05 [p = 0.002]). The mean incidence of reoperations was significantly higher in patients undergoing ATPLIF than in those undergoing LTP-LIF (ES 0.02, 95% CI 0.01–0.03 vs ES 0.04, 95% CI 0.02–0.07; p = 0.012). The mean incidence of permanent deficits was similar between the two groups (stand-alone: ES 0.03, 95% CI 0.01–0.06 vs ES 0.05, 95% CI 0.01–0.12 [p = 0.204]; combined: ES 0.03, 95% CI 0.01–0.06 vs ES 0.03, 95% CI 0.00–0.08 [p = 0.595]). The postoperative changes in visual analog scale (VAS) and Oswestry Disability Index (ODI) scores were both found to be higher for ATP-LIF relative to LTP-LIF (VAS: weighted average 4.11 [SD 2.03] vs weighted average 3.75 [SD 1.94] [p = 0.004]; ODI: weighted average 28.3 [SD 5.33] vs weighted average 24.3 [SD 4.94] [p < 0.001]).

CONCLUSIONS These analyses indicate that while both approaches are associated with similar fusion rates, ATP-LIF may be related to higher odds of cage movement and reoperations as compared with LTP-LIF. Furthermore, there is no difference in rates of permanent deficits between the two procedures.

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Oblique lumbar interbody fusion at L5S1(OLIF51)

Acta Neurochirurgica (2019) 161:1079–1083

OLIF51 retains the advantages of traditional ALIF procedure with good fusion rates and improvement in radiographic parameters and reduces its drawbacks. It has the added advantage of being a minimal access technique.

Methods Preoperative analysis of the vascular anatomy using CT angiography is mandatory. OLIF51 is done in right lateral position using specialized retractor blades and Thompson retractor system. The procedure is similar to OLIF at other levels except for the differences described here. The instruments are specialized for OLIF at L5S1.

Conclusion OLIF51 provides an excellent alternative to traditional ALIF

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