Anterior lumbar compared to oblique lumbar interbody approaches for multilevel fusions to the sacrum in adults with spinal deformity and degeneration

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  • 1 Department of Neurological Surgery,
  • 2 Division of Vascular Surgery, and
  • 3 Department of Orthopedic Surgery, University of California, San Francisco, California; and
  • 4 Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
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OBJECTIVE

In adult spinal deformity and degenerative conditions of the spine, interbody fusion to the sacrum often is performed to enhance arthrodesis, induce lordosis, and alleviate stenosis. Anterior lumbar interbody fusion (ALIF) has traditionally been performed, but minimally invasive oblique lumbar interbody fusion (OLIF) may or may not cause less morbidity because less retraction of the abdominal viscera is required. The authors evaluated whether there was a difference between the results of ALIF and OLIF in multilevel anterior or lateral interbody fusion to the sacrum.

METHODS

Patients from 2013 to 2018 who underwent multilevel ALIF or OLIF to the sacrum were retrospectively studied. Inclusion criteria were adult spinal deformity or degenerative pathology and multilevel ALIF or OLIF to the sacrum. Demographic, implant, perioperative, and radiographic variables were collected. Statistical calculations were performed for significant differences.

RESULTS

Data from a total of 127 patients were analyzed (66 OLIF patients and 61 ALIF patients). The mean follow-up times were 27.21 (ALIF) and 24.11 (OLIF) months. The mean surgical time was 251.48 minutes for ALIF patients and 234.48 minutes for OLIF patients (p = 0.154). The mean hospital stay was 7.79 days for ALIF patients and 7.02 days for OLIF patients (p = 0.159). The mean time to being able to eat solid food was 4.03 days for ALIF patients and 1.30 days for OLIF patients (p < 0.001). After excluding patients who had undergone L5–S1 posterior column osteotomy, 54 ALIF patients and 41 OLIF patients were analyzed for L5–S1 radiographic changes. The mean cage height was 14.94 mm for ALIF patients and 13.56 mm for OLIF patients (p = 0.001), and the mean cage lordosis was 15.87° in the ALIF group and 16.81° in the OLIF group (p = 0.278). The mean increases in anterior disc height were 7.34 mm and 4.72 mm for the ALIF and OLIF groups, respectively (p = 0.001), and the mean increases in posterior disc height were 3.35 mm and 1.24 mm (p < 0.001), respectively. The mean change in L5–S1 lordosis was 4.33° for ALIF patients and 4.59° for OLIF patients (p = 0.829).

CONCLUSIONS

Patients who underwent multilevel OLIF and ALIF to the sacrum had comparable operative times. OLIF was associated with a quicker ileus recovery and less blood loss. At L5–S1, ALIF allowed larger cages to be placed, resulting in a greater disc height change, but there was no significant difference in L5–S1 segmental lordosis.

ABBREVIATIONS ALIF = anterior lumbar interbody fusion; CCI = Charlson Comorbidity Index; LLIF = lateral lumbar interbody fusion; OLIF = oblique lumbar interbody fusion; PCO = posterior column osteotomy; TLIF = transforaminal lumbar interbody fusion.

Supplementary Materials

    • Supplemental Table 1 (PDF 379 KB)

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Contributor Notes

Correspondence Zhuo Xi: University of California, San Francisco, CA. neurosurgeon-xz@hotmail.com.

INCLUDE WHEN CITING Published online June 12, 2020; DOI: 10.3171/2020.4.SPINE20198.

Disclosures Dr. Chou reports being a consultant for Globus and Medtronic; he receives royalties from Globus. Dr. Mummaneni reports being a consultant for DePuy Synthes, Globus, and Stryker; he owns stock in Spinicity/ISD; he receives royalties from DePuy Synthes, Thieme Publishers, and Springer Publishing; and he receives support of non–study-related clinical or research efforts that he oversees from the following: AO Spine, NREF, and ISSG. Dr. Eichler reports being a consultant for Medtronic and NuVasive. Dr. Burch reports being a consultant for Medtronic and Zimmer Biomet.

  • 1

    Mobbs RJ, Phan K, Malham G, Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF. J Spine Surg. 2015;1(1):218.

    • Search Google Scholar
    • Export Citation
  • 2

    Phan K, Thayaparan GK, Mobbs RJ. Anterior lumbar interbody fusion versus transforaminal lumbar interbody fusion—systematic review and meta-analysis. Br J Neurosurg. 2015;29(5):705711.

    • Search Google Scholar
    • Export Citation
  • 3

    Mobbs RJ, Phan K, Daly D, Approach-related complications of anterior lumbar interbody fusion: results of a combined spine and vascular surgical team. Global Spine J. 2016;6(2):147154.

    • Search Google Scholar
    • Export Citation
  • 4

    Dorward IG, Lenke LG, Bridwell KH, Transforaminal versus anterior lumbar interbody fusion in long deformity constructs: a matched cohort analysis. Spine (Phila Pa 1976). 2013;38(12):E755E762.

    • Search Google Scholar
    • Export Citation
  • 5

    Schroeder GD, Kepler CK, Millhouse PW, L5/S1 fusion rates in degenerative spine surgery: a systematic review comparing ALIF, TLIF, and axial interbody arthrodesis. Clin Spine Surg. 2016;29(4):150155.

    • Search Google Scholar
    • Export Citation
  • 6

    Pinson H, Hallaert G, Herregodts P, Outcome of anterior lumbar interbody fusion: a retrospective study of clinical and radiologic parameters. World Neurosurg. 2017;103:772779.

    • Search Google Scholar
    • Export Citation
  • 7

    Ajiboye RM, Alas H, Mosich GM, Radiographic and clinical outcomes of anterior and transforaminal lumbar interbody fusions: a systematic review and meta-analysis of comparative studies. Clin Spine Surg. 2018;31(4):E230E238.

    • Search Google Scholar
    • Export Citation
  • 8

    Lee CS, Park SJ, Chung SS, Mini-open anterior lumbar interbody fusion combined with lateral lumbar interbody fusion in corrective surgery for adult spinal deformity. Asian Spine J. 2016;10(6):10231032.

    • Search Google Scholar
    • Export Citation
  • 9

    Quillo-Olvera J, Lin GX, Jo HJ, Kim JS. Complications on minimally invasive oblique lumbar interbody fusion at L2-L5 levels: a review of the literature and surgical strategies. Ann Transl Med. 2018;6(6):101.

    • Search Google Scholar
    • Export Citation
  • 10

    Xu DS, Walker CT, Godzik J, Minimally invasive anterior, lateral, and oblique lumbar interbody fusion: a literature review. Ann Transl Med. 2018;6(6):104.

    • Search Google Scholar
    • Export Citation
  • 11

    Woods KR, Billys JB, Hynes RA. Technical description of oblique lateral interbody fusion at L1-L5 (OLIF25) and at L5-S1 (OLIF51) and evaluation of complication and fusion rates. Spine J. 2017;17(4):545553.

    • Search Google Scholar
    • Export Citation
  • 12

    Tropiano P, Giorgi H, Faure A, Blondel B. Surgical techniques for lumbo-sacral fusion. Orthop Traumatol Surg Res. 2017;103(1S):S151S159.

    • Search Google Scholar
    • Export Citation
  • 13

    Mobbs RJ, Phan K, Assem Y, Combination Ti/PEEK ALIF cage for anterior lumbar interbody fusion: early clinical and radiological results. J Clin Neurosci. 2016;34:9499.

    • Search Google Scholar
    • Export Citation
  • 14

    Kim DB, Shin MH, Kim JT. Vertebral body rotation in patients with lumbar degenerative scoliosis: surgical implication for oblique lumbar interbody fusion. World Neurosurg. 2019;124:e226e232.

    • Search Google Scholar
    • Export Citation
  • 15

    DiGiorgio AM, Edwards CS, Virk MS, Stereotactic navigation for the prepsoas oblique lateral lumbar interbody fusion: technical note and case series. Neurosurg Focus. 2017;43(2):E14.

    • Search Google Scholar
    • Export Citation
  • 16

    Ohtori S, Orita S, Yamauchi K, Mini-open anterior retroperitoneal lumbar interbody fusion: oblique lateral interbody fusion for lumbar spinal degeneration disease. Yonsei Med J. 2015;56(4):10511059.

    • Search Google Scholar
    • Export Citation
  • 17

    Silvestre C, Mac-Thiong JM, Hilmi R, Roussouly P. Complications and morbidities of mini-open anterior retroperitoneal lumbar interbody fusion: oblique lumbar interbody fusion in 179 patients. Asian Spine J. 2012;6(2):8997.

    • Search Google Scholar
    • Export Citation
  • 18

    Zairi F, Sunna TP, Westwick HJ, Mini-open oblique lumbar interbody fusion (OLIF) approach for multi-level discectomy and fusion involving L5-S1: preliminary experience. Orthop Traumatol Surg Res. 2017;103(2):295299.

    • Search Google Scholar
    • Export Citation
  • 19

    Phan K, Maharaj M, Assem Y, Mobbs RJ. Review of early clinical results and complications associated with oblique lumbar interbody fusion (OLIF). J Clin Neurosci. 2016;31:2329.

    • Search Google Scholar
    • Export Citation
  • 20

    Phan K, Xu J, Scherman DB, Anterior lumbar interbody fusion with and without an “access surgeon”: a systematic review and meta-analysis. Spine (Phila Pa 1976). 2017;42(10):E592E601.

    • Search Google Scholar
    • Export Citation
  • 21

    Härtl R, Joeris A, McGuire RA. Comparison of the safety outcomes between two surgical approaches for anterior lumbar fusion surgery: anterior lumbar interbody fusion (ALIF) and extreme lateral interbody fusion (ELIF). Eur Spine J. 2016;25(5):14841521.

    • Search Google Scholar
    • Export Citation
  • 22

    Liu L, Liang Y, Zhang H, Imaging anatomical research on the operative windows of oblique lumbar interbody fusion. PLoS One. 2016;11(9):e0163452.

    • Search Google Scholar
    • Export Citation
  • 23

    Chung NS, Jeon CH, Lee HD, Kweon HJ. Preoperative evaluation of left common iliac vein in oblique lateral interbody fusion at L5-S1. Eur Spine J. 2017;26(11):27972803.

    • Search Google Scholar
    • Export Citation
  • 24

    Wang K, Zhang C, Wu H, The anatomic characteristics of the retroperitoneal oblique corridor to the L1-S1 intervertebral disc spaces. Spine (Phila Pa 1976). 2019;44(12):E697E706.

    • Search Google Scholar
    • Export Citation
  • 25

    Than KD, Wang AC, Rahman SU, Complication avoidance and management in anterior lumbar interbody fusion. Neurosurg Focus. 2011;31(4):E6.

  • 26

    Hah R, Kang HP. Lateral and oblique lumbar interbody fusion—current concepts and a review of recent literature. Curr Rev Musculoskelet Med. 2019;12:305310.

    • Search Google Scholar
    • Export Citation

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