Is Oblique Lumbar Interbody Fusion Superior to Minimally Invasive Transforaminal Lumbar Interbody Fusion for the Treatment of Lumbar Degenerative Disease?

Abstract

Abstract Study Design: Retrospective case‒control study. Purpose To compare oblique lumbar interbody fusion (OLIF) and minimally invasive transforaminal lumbar interbody fusion (Mis-TLIF) approaches for the treatment of lumbar degenerative disease. Methods A total of 127 patients underwent single-level MIS TLIF, and 88 patients underwent OLIF with posterior bilateral percutaneous pedicle screws. Demographic characteristics, surgical information, and perioperative complications were compared between the OLIF and Mis-TLIF groups. The Visual Analog Scale (VAS), Oswestry Disability Index (ODI) and 36-Item Short Form Survey Instrument (SF-36) were administered for clinical evaluations. Results Patients who underwent OLIF had a significantly shorter surgery time (93.1 ± 14.6 min vs. 111.1 ± 13.5 min), lower volume of blood loss (61.1 ± 15.5 ml vs. 169.0 ± 36.4 ml), fewer fluoroscopic times (23.2 ± 7.6 times vs. 42.9 ± 5.1 times), shorter hospital stay (3.1 ± 0.7 days vs. 5.1 ± 1.0 days), and earlier time to ambulation (1.9 ± 0.6 days vs. 3.6 ± 0.8 days) than those who underwent Mis-TLIF. Significant clinical improvement was observed in terms of scores on the VAS, ODI, and SF-36 when comparing the preoperative evaluation and the final follow-up. VAS back scores, ODI scores, and SF-36 scores were not significantly different between the OLIF and Mis-TLIF groups after one year of follow-up. Five patients suffered from cage subsidence in the OLIF group, while nineteen cases of cage subsidence occurred in the Mis-TLIF group. Conclusions Both OLIF and MIS-TLIF were effective approaches for the treatment of lumbar degenerative diseases. The OLIF procedure has a shorter operative time, lower blood loss, earlier time to ambulation, shorter hospital stay, and lower rate of cage subsidence than the MIS-TLIF procedure. There were no significant differences in long-term clinical evaluations between the OLIF and MIS-TLIF groups. However, it is very important for spine surgeons to choose the optimal surgical approach to achieve beneficial outcomes during the treatment of lumbar degenerative diseases.