Usefulness of Oblique Lumbar Interbody Fusion as Revision Surgery: Comparison of Clinical and Radiological Outcomes Between Primary and Revision Surgery.

Abstract

Oblique lumbar interbody fusion (OLIF) is useful as surgical treatment of degenerative lumbar disease. However, revision surgery has often resulted in worse surgical outcomes than primary surgery. Thus, we compared the usefulness of OLIF as primary surgery (PS) versus revision surgery (RS). We retrospectively investigated 173 patients who had undergone single-level OLIF from 2016 to 2018. The radiological and clinical outcomes were compared between PS (n = 152) and RS (n = 21). The effects of RS on the clinical outcomes (Oswestry Disability Index [ODI] cutoff, 12) after surgery were investigated. The ODI and visual analog scale score at 6 and 12 months after surgery was worse in the RS group than in the PS group (P < 0.05). In the RS group, the visual analog scale score for leg pain of the previous laminectomy side was worse than that of the virgin side at 6 and 12 months after surgery (P < 0.05). The disc height, ligamentum flavum, and subsidence did not differ between the 2 groups. However, the cross-sectional area enlargement differed between the 2 groups (P < 0.05). Multivariate logistic regression analysis showed that RS and severe subsidence were risk factors for differences in the ODI (P = 0.006 and P = 0.017, respectively). Most radiological outcomes were similar between the RS and PS groups, with no differences in complications or the requirement for additional posterior decompression. However, OLIF resulted in relatively poor clinical outcomes when used as RS. Thus, revision spine surgery tends to result in poor outcomes compared with those of primary spine surgery; however, OLIF can be a tolerable option for revision spine surgery.