Ibero-Latin American Consensus on Oblique Lumbar Interbody Fusion (L2-L5): A Modified Delphi Study.

Abstract

To establish expert consensus on the surgical application of oblique lumbar interbody fusion at the L2/5 spinal level (OLIF 25) using a modified Delphi process. Seventeen experienced spine surgeons from Iberia and Latin America participated in a four-round Delphi process (one face-to-face and three online surveys) conducted between July 2024 and April 2025. Consensus was defined as ≥70% agreement and graded as strong (≥90%), moderate (80%-89.9%), or weak (70%-79.9%). A total of 56 statements across four domains (preoperative assessment, technology/instrumentation, intraoperative considerations, postoperative care) were evaluated. Consensus was achieved for 45 statements (80.4%), including 11 with strong agreement, 17 moderate, and 6 weak. Additional items were classified as optional recommendations (12.5%) or findings (7.1%). Key agreements included mandatory magnetic resonance imaging for corridor assessment, indirect foraminal decompression, and grade I degenerative spondylolisthesis as favorable indications. Major contraindications were severe canal stenosis with blocked facets and prior ipsilateral retroperitoneal surgery. High-risk steps identified were pin fixation, tubular retractor opening, and anterior longitudinal ligament release. This study provides the first Delphi-based regional consensus specifically addressing OLIF 25. It delivers structured expert guidance on imaging, indications, contraindications, and intraoperative safety maneuvers, offering a framework to standardize OLIF 25 practice in Ibero-Latin America.