Direct Lumbar Interbody Fusion (DLIF) vs Oblique Lumbar Interbody Fusion (OLIF): A Comparison Study of Perioperative Complications

Presented at SMISS Annual Forum 2014
By Jin-Sung Kim MD, PhD
With

Disclosures: Jin-Sung Kim MD, PhD None

Introduction:
DLIF and OLIF both have gained wide acceptance among surgeons as minimally invasive retroperitoneal procedures that provide direct access and visualization of intervertebral discs, with potentially lower rate of morbidity. DLIF and OLIF are different in terms of corridor of approach, and structures encountered during approach.

Aims/Objectives:
The aim of this study is to compare the intraoperative and postoperative results of these techniques, including complications.

Methods:
A total of 44 patients were operated by a single surgeon at our institution between November 2011 and December 2013. All approaches were through minimally invasive retroperitoneal approach. Mean follow up period was 12.7±6.8 months. Intraoperative and postoperative complications were noted.

Results:
In the DLIF group, mean age of patients was 67.8±6.2 years, with BMI of 23.2 (±4.4). The procedure was performed in the lumbar spine at L1-L2 in 1(2.2%), L2-L3 in 14(31.8%), L3-L4 in 13(29.5%), and L4-L5 in 16(36.3%). Mean blood loss was 147.2±24.3 ml and mean operating time was 72.6±22.2 minutes. Mean hospital stay was 16.6±13.4 days. In the OLIF group, mean age of patients was 63.4±9.1 years, with BMI of 24.1±3.9. The procedure was performed in the lumbar spine at L2-L3 in 9(24.3%), L3-L4 in 17(45.9%), and L4-L5 in 11(29.7%). Mean blood loss was 110.2±14.5 ml and mean operating time was 60.5±23.3 minutes. Mean hospital stay was 12.1±7.1 days. Number of segments operated on was 1 in 50% of the patients in the DLIF group, as compared to 2 segments in 50% of the patients in the OLIF group. In the DLIF group, there were 11 cases of complications, 27% of which was transient ipsilateral leg weakness. In the OLIF group, there were 4 cases, and 67% was transient abdominal pain. There were no cases of persistent leg weakness, abdominal weakness or hernia.

Conclusions:
Both minimally invasive DLIF and OLIF can be performed easily and safely in the lumbar spine from L2 to L5, and at L1-2 in selected cases. OLIF is significantly superior to DLIF in terms of mean blood loss, operating time and mean hospital stay (p < 0.05). OLIF is also associated with significantly lower number of complications attributable to lumbosacral nerve plexus injury and psoas weakness.