Lee JooYoung, Cho JaeHwan, Lee Dong-Ho, Hwang ChangJu, Park SeHan
Department of Orthopedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Republic of Korea.
Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea.
J Clin Med. 2025 Sep 18;14(18):6570. doi: 10.3390/jcm14186570.
Oblique lumbar interbody fusion (OLIF) has recently gained popularity as a minimally invasive surgical technique for lumbar fusion. While OLIF is superior in restoring disc height and lumbar lordosis compared to posterior lumbar interbody fusion (PLIF), its biomechanical effect on adjacent segments remains unclear. We retrospectively analyzed 236 patients who underwent one- or two-level OLIF ( = 95) or PLIF ( = 141) between 2013 and 2020. Radiographic outcomes, including lumbar lordosis, upper adjacent segmental lordosis, retrolisthesis, and foraminal height, were evaluated preoperatively and at 3 days and 1, 3, 6, and 12 months postoperatively. Patient-reported outcomes (VAS for back/leg pain and Oswestry Disability Index [ODI]) were assessed preoperatively and at 12 months. OLIF provided superior restoration of lumbar lordosis (4.03 ± 4.38° vs. 1.63 ± 5.11°, = 0.001) and disc height (5.50 ± 3.39 mm vs. 2.71 ± 2.18 mm, < 0.0001) compared with PLIF. However, OLIF was associated with higher incidence (76.9% vs. 24.6%, < 0.0001) and degree of retrolisthesis (1.69 ± 1.09 mm vs. 0.29 ± 0.70 mm, < 0.0001), and decreased foraminal height (-1.43 ± 2.12 mm vs. 0.54 ± 2.53 mm, < 0.0001) in the upper adjacent segment. Importantly, there was no significant difference in clinical outcomes (VAS and ODI) between the two groups at 12 months (all > 0.05). While OLIF achieves superior restoration of lumbar lordosis and disc height compared to PLIF, it also induces early radiographic deterioration in the upper adjacent segment. Importantly, these findings represent radiographic changes observed within 1 year, without significant differences in clinical outcomes, and longer-term follow-up is required to determine their clinical relevance.
斜外侧腰椎椎间融合术（OLIF）作为一种腰椎融合的微创手术技术，近年来越来越受欢迎。与后路腰椎椎间融合术（PLIF）相比，OLIF在恢复椎间盘高度和腰椎前凸方面更具优势，但其对相邻节段的生物力学影响仍不明确。我们回顾性分析了2013年至2020年间接受单节段或双节段OLIF（n = 95）或PLIF（n = 141）的236例患者。评估术前以及术后3天、1个月、3个月、6个月和12个月时的影像学结果，包括腰椎前凸、上位相邻节段前凸、椎体后滑脱和椎间孔高度。在术前和术后12个月评估患者报告的结果（背部/腿部疼痛视觉模拟评分[VAS]和Oswestry功能障碍指数[ODI]）。与PLIF相比，OLIF在恢复腰椎前凸（4.03±4.38°对1.63±5.11°，P = 0.001）和椎间盘高度（5.50±3.39 mm对2.7±2.18 mm，P < 0.0001）方面更具优势。然而，OLIF与更高的椎体后滑脱发生率（76.9%对24.6%，P < 0.0001）和程度（1.69±1.09 mm对0.29±0.70 mm，P < 0.0001）相关，并且上位相邻节段的椎间孔高度降低（-1.43±2.12 mm对0.54±2.53 mm，P < 0.0001）。重要的是，两组在术后12个月时的临床结果（VAS和ODI）没有显著差异（均P > 0.05）。虽然与PLIF相比，OLIF在恢复腰椎前凸和椎间盘高度方面更具优势，但它也会导致上位相邻节段早期影像学退变。重要的是，这些发现代表了1年内观察到的影像学变化，临床结果没有显著差异，需要进行更长时间的随访以确定它们的临床相关性。
