Vascular complications after anterior lumbar interbody fusion or oblique lumbar interbody fusion.

Abstract

Adequate exposure of the anterior and lateral spinal columns, requiring mobilization of major vascular structures, is critical to instrumented lumbar spine surgery. Anterior lumbar interbody fusion (ALIF) has traditionally been the primary approach, but oblique lumbar interbody fusion (OLIF) is increasingly used. We aimed to compare intraoperative and postoperative vascular outcomes between ALIF and OLIF approaches. A retrospective chart review identified all patients who underwent ALIF or OLIF for lumbar spine surgery between January 2017 and July 2023 at a single tertiary care center. Primary outcomes included frequency and level of vascular injury, as well as estimated blood loss. Secondary outcomes included operative times and other intra- and perioperative parameters. Adjusted analyses were performed using inverse probability of treatment weighting based on propensity scores. A total of 292 procedures were included (222 ALIF, 70 OLIF). Rates of vascular injury were similar between ALIF and OLIF after inverse probability of treatment weighting (ALIF vs OLIF: 9.5% vs 9.4%, P = .98) as well as similar blood loss overall (155 [28] cc vs 323 [178] cc, P = .16). Injuries at L4-L5 were more frequent in ALIF (5.3% vs 0%), and L5-S1 injuries were higher during OLIF (2.6% vs 7.7%, P = .015). Procedure duration was longer for OLIF than for ALIF (132 [6] minutes vs 260 [14] minutes, P < .001). No differences were observed in other postoperative outcomes, including injuries to surrounding structures, surgical site infections, and length of hospital stay. In this cohort, ALIF and OLIF approaches demonstrated comparable rates of vascular injury and estimated blood loss overall; however, the level of injury differed between the procedures, with more distal injuries at L5-S1 during OLIF. OLIF procedures were also associated with longer procedure times. Both approaches remain safe and effective options for lumbar spine access when performed in high-volume centers.