Emami Arash, Patel Neil, Coban Daniel, Saela Stephen, Sinha Kumar, Faloon Michael, Hwang Ki Soo
Department of Orthopaedic Surgery, St. Joseph's University Medical Center, 703 Main St, Paterson, NJ 07503, United States.
N Am Spine Soc J. 2023 Apr 3;14:100216. doi: 10.1016/j.xnsj.2023.100216. eCollection 2023 Jun.
Oblique lumbar interbody fusion (OLIF) and extreme lateral interbody fusion (XLIF) are 2 popular minimally invasive spinal fusion techniques with unique approach-related complication profiles. Accordingly, patient-specific anatomical factors, such as vascular anatomy or iliac crest height, greatly influence which technique to use. Previous studies comparing these approaches do not account for the inability of XLIF to access the L5-S1 disc space and therefore do not exclude this level in their analysis. The purpose of this study was to compare radiological and clinical outcomes of these techniques in the L1-L5 region.
A query of 3 electronic databases (PubMed, CINAHL plus, and SCOPUS) was performed, without time restriction, to identify studies that evaluated outcomes of single-level OLIF and/or XLIF between L1 and L5. Based on heterogeneity, a random effects meta-analysis was performed to evaluate the pooled estimation of each variable between the groups. An overlap of 95% confidence intervals suggests no statistically significant difference at the p<.05 level.
A total of 1,010 patients (408 OLIF, 602 XLIF) were included from 24 published studies. Improvements in disc height (OLIF: 4.2 mm; XLIF: 5.3 mm), lumbar segmental (OLIF: 2.3°; XLIF: 3.1°), and lumbar lordotic angles (OLIF: 5.3°; XLIF: 3.3°) showed no significant difference. The rate of neuropraxia was significantly greater in the XLIF group at 21.2% versus 10.9% in the OLIF group (p<.05). However, the rate of vascular injury was higher in the OLIF cohort at 3.2% (95% CI:1.7-6.0) as compared to 0.0 (95% CI: 0.0-1.4) in the XLIF cohort. Improvements in VAS-b (OLIF: 5.6; XLIF: 4.5) and ODI (OLIF: 37.9; XLIF: 25.6) scores were not significantly different between the 2 groups.
This meta-analysis demonstrates similar clinical and radiological outcomes between single-level OLIF and XLIF from L1 to L5. XLIF had significantly higher rates of neuropraxia, whereas OLIF had greater rates of vascular injury.
斜外侧腰椎椎间融合术（OLIF）和极外侧腰椎椎间融合术（XLIF）是两种流行的微创脊柱融合技术，各有独特的与手术入路相关的并发症情况。因此，患者特定的解剖因素，如血管解剖结构或髂嵴高度，对选择使用哪种技术有很大影响。以往比较这些手术入路的研究没有考虑到XLIF无法进入L5 - S1椎间盘间隙这一情况，因此在分析中未排除该节段。本研究的目的是比较这两种技术在L1 - L5区域的影像学和临床结果。
对3个电子数据库（PubMed、CINAHL plus和SCOPUS）进行无时间限制的检索，以确定评估L1至L5单节段OLIF和/或XLIF结果的研究。基于异质性，进行随机效应荟萃分析以评估两组间各变量的合并估计值。95%置信区间重叠表明在p <.05水平无统计学显著差异。
共纳入24项已发表研究中的1010例患者（408例OLIF，602例XLIF）。椎间盘高度改善（OLIF：4.2 mm；XLIF：5.3 mm）、腰椎节段角度（OLIF：2.3°；XLIF：3.1°）和腰椎前凸角（OLIF：5.3°；XLIF：3.3°）无显著差异。XLIF组神经失用症发生率显著高于OLIF组，分别为21.2%和10.9%（p <.05）。然而，OLIF队列中血管损伤发生率为3.2%（95% CI：1.7 - 6.0），高于XLIF队列中的0.0（95% CI：0.0 - 1.4）。两组间视觉模拟评分法 - 背痛（VAS - b）（OLIF：5.6；XLIF：4.5）和腰椎功能障碍指数（ODI）（OLIF：37.9；XLIF：25.6）评分改善无显著差异。
这项荟萃分析表明，L1至L5单节段OLIF和XLIF的临床和影像学结果相似。XLIF的神经失用症发生率显著更高，而OLIF的血管损伤发生率更高。
