Comparison of Minimal invasive Transforaminal Lumbar Interbody Fusion with Oblique Lumbar Interbody Fusion for L4-5: Clinical and Radiological Outcomes

Presented at SMISS Annual Forum 2016
By Hyun-Jin Jo
With Jin-Sung Kim MD, PhD,

Disclosures: Hyun-Jin Jo None Jin-Sung Kim MD, PhD None,

Introduction

Minimally invasive oblique lateral interbody fusion (OLIF) has gradually increased popularity as substituted method
of lateral approach to lumbar fusion.

Aims/Objectives

Even though there are few comparison literatures between MIS-lateral interbody fusion (XLIF) and MIS-TLIF, there is no comparison report between MIS-OLIF and MIS-TLIF. With this study, we have done comarison between clinical and radiological outcomes through 1-year postoperative about L4-5 level

Methods

A retrospective review was performed on the medical records and radiographs of 30 and 35 patients who underwent OLIF and MIS- TLIF between June 2015 and June 2013. Clinical outcomes were compared with a visual analog scale (VAS) and the Oswestry disability index (ODI). The preoperative and postoperative disc heights, segmental and whole lumbar lordosis were measured on radiographs. Fusion rates, subsidence rates, operative time, Mean blood loss, length of hospital stay, and complications were assessed.

Results

OLIF was superior to MIS-TLIF regarding its ability to restore disc height. The average disc height restored from 8.35mm preoperative to 10.43mm at the last follow up in MIS-TLIF group and from 7.95mm to 12.53 in OLIF group (p= 0.007). OLIF group (16.9%) experienced less subsidence than MIS-TLIF group (35.8%) by 12 months postoperative (p=0.003) There was no definitely different of changing the postoperative segmental lordosis and whole lumbar lordosis (both p<0.0001). Fusion rate was also no definitely different between OLIF and MIS-TLIF (89.5% vs 91.8%) The changes of VAS and ODI between the MIS-TLIF and OLIF were not significantly different (p>0.05). There were no definitely different of perioperative Mean blood loss, operating time and length of hospital stay between two groups. (p>0.05) postoperative complication wasn’t occurred in MIS-TLIF but minor complications were occurred in OLIF (lumbar plexopathy 13.3%, sympathetic injury 10%)during the follow up periods. All of these minor complication resolved within 3 months postoperatively. 

Conclusions

Both OLIF and MIS-TLIF are less invasive and thus good surgical option for treating degenerative lumbar disease. OLIF has higher potential in increasing postoperative disc height and decreasing postoperative subsidence. And otherwise postoperative radiological and clinical outcomes weren’t definitely different between two groups. Postoperative complications were noted only OLIF group. However these were minor complications and were resolved spontaneously.