Clinical Outcomes of Biportal Endoscopic Interlaminar Decompression with Oblique Lumbar Interbody Fusion (OLIF): Comparative Analysis with TLIF.

Ho-Jin Lee,Jae-Sung Ahn,Eugene J Park,Young-Cheol Park,Youk-Sang Kwon,Sang Bum Kim

doi:10.3390/brainsci11050630

Abstract

Oblique lumbar interbody fusion (OLIF) improves the spinal canal, with favorable clinical outcomes. However, it may not be useful for treating concurrent, severe central canal stenosis (SCCS). Therefore, we added biportal endoscopic spinal surgery (BESS) after OLIF, evaluated the combined procedure for one-segment fusion with clinical outcomes, and compared it to open conventional TLIF. Patients were divided into two groups: Group A underwent BESS with OLIF, and Group B were treated via TLIF. The length of hospital stay (LOS), follow-up period, operative time, estimated blood loss (EBL), fusion segment, complications, and clinical outcomes were evaluated. Clinical outcomes were measured using Visual Analog Scale (VAS) scores, Oswestry Disability Index (ODI) scores, and the modified Macnab criteria. All the clinical parameters improved significantly after the operation in Group A. The only significant between-group difference was that the EBL was significantly lower in Group A. At the final follow-up, no clinical parameter differed significantly between the groups. No complications developed in either group. We suggest that our combination technique is a useful, alternative, minimally invasive procedure for the treatment of one-segment lumbar SCCS associated with foraminal stenosis or segmental instability.

Highlights

Lateral lumbar interbody fusion (LLIF) is a minimally invasive procedure used to treat degenerative spinal diseases and includes extreme lateral interbody fusion (XLIF), direct lateral interbody fusion (DLIF), and oblique lumbar interbody fusion (OLIF) [1,2,3]
OLIF featuring an oblique corridor has recently been used to reduce complications associated with XLIF and DLIF, including possible lumbar plexus injury, psoas muscle injury attributable to use of the transpsoas approach, and anatomical obstacles encountered during the approach on the level of the lumbosacral junction [3,4,24,25,26]
Oliveira et al [5] reported that severe central canal stenosis combined with lateral or foraminal stenosis attributable to osteophyte formation was a contraindication for LLIF; in that study, the additional decompression of such lesions was required given the persistence of stenotic symptoms

Summary

Introduction

Lateral lumbar interbody fusion (LLIF) is a minimally invasive procedure used to treat degenerative spinal diseases and includes extreme lateral interbody fusion (XLIF), direct lateral interbody fusion (DLIF), and oblique lumbar interbody fusion (OLIF) [1,2,3]. LLIF corrects coronal and sagittal deformities via ligamentotaxis and indirectly decompresses the neural canal by restoring disc height, stabilizing segmental instability, and remodeling the spinal canal [2,4,5,6]. Indirect decompression affords various advantages compared to direct decompression, including lower risks of neural injury, incidental durotomy, and postoperative perineural fibrosis [4,7]. OLIF enables cage insertion with less psoas injury and no need for nerve monitoring. It offers easy access during lumbosacral junction-level surgery. The iliac crest, which poses an obstacle during XLIF or DLIF, is evaded [4]

Methods

Discussion

Conclusion