The Alternative Approach to the Lumbosacral Segment: The Right-Sided Oblique Lumbar Interbody Fusion Compared with Anterior Lumbar Interbody Fusion.

Abstract

Anterior lumbar interbody fusion with dorsal percutaneous pedicle screw fixation (ALIF+D) is a well-described technique treating lumbosacral degenerative diseases. Mobilizing the common iliac arteries and veins during the ALIF+D approach may increase the risk of bleeding when the bifurcations are low. This study demonstrates that in such cases, the right-sided oblique lumbar interbody fusion with dorsal percutaneous pedicle screw fixation (OLIF+D) offers a novel alternative to the ALIF+D approach. Twenty-one patients were operated on with the ALIF+D approach, and 20 patients were operated on using the right-sided OLIF+D technique. Computed tomography-based imaging and clinical data, such as patient-reported outcomes, were collected. Both ALIF+D and OLIF+D surgeries elicited a statistically significant decrease (P ≤ 0.001) between the preoperative and postoperative Oswestry disability index and the back and leg pain visual analog scale scores. A significant increase was observed in both techniques between preoperative and postoperative anterior segmental height, posterior segmental height, and segmental lordosis (P ≤ 0.001). There were no statistically significant postoperative differences between patients operated by ALIF+D and patients operated by OLIF+D in the segmental lordosis angle (P = 0.354), anterior segmental height (P = 0.297), posterior segmental height (P = 0.404), Oswestry disability index (P = 0.824), or back and leg visual analog scale scores (P = 0.682 and P = 0.979, respectively). The OLIF+D group showed trend-like higher blood loss (198 ± 118 mL vs. 134 ± 77 mL; P = 0.058) and significantly longer surgical time (199 ± 47 vs. 169 ± 54 minutes; P = 0.009) compared to the ALIF+D group. The right-sided lumbosacral OLIF+D approach is an alternative to the ALIF+D approach if the latter is hazardous due to vessel anatomy.