Introduction: Minimally invasive oblique lateral interbody fusion (OLIF) has steadily gained popularity as the fusion method of choice in patients with spondylolisthesis or foraminal stenosis. However, the complication rates reported in the literature vary greatly between authors. In this research the authors report the clinical outcomes and peri-operative complications of OLIF at L4-5.
Methods: The authors retrospectively reviewed prospectively acquired records of patients with L4–5 spondylolisthesis or foraminal stenosis who had undergone OLIF between 2013 and 2015. 29 patients underwent single level OLIF at L4-5 or two level OLIF including L4-5. Among 29 patients, 4 patients TLIF or PLF at other level with OLIF at L4-5. Outpatient clinic follow-up were scheduled at 1, 3, 6, 12, and 24 months postoperatively. Outcome measures included visual analog scale (VAS), Oswestry Disability Index (ODI), fusion and subsidence rates, and peri-operative complications.
Results: Twenty-nine patients (9 males, 20 females, and mean age 66.9 years) met the study inclusion criteria. After OLIF procedures, all patients underwent percutaneous pedicle screw fixation in prone position, with additional posterior laminectomy in 3 patients. The average VAS score for back/leg improved from 6.3/6.5 to 3.1 /2.1 at the last follow-up (both p<0.0001). The average ODI score improved from 50.4 preoperatively to 27.2 at the last follow-up (p < 0.0001). Radiological evidence of fusion on computed tomography scans was noted in 57.0% of the patients in 6 months and 92.9% in 12 months. Subsidence during the follow-up periods occurred in 8 (21.6%) out of 37 OLIF levels in 29 patients. Lumbar plexopathy was noted in 4 (13.5%) patients, and consisted of transient motor weakness in 3 (10.3%) patients and numbness in different in 3 (10.3%) patients (Sensory Dermal Zone III in 2, II in 1). All lumbar plexopathy symptoms resolved within 4 weeks postoperatively. Evidence of sympathetic injury on physical examination and digital infra-red thermal imaging was noted in 4 (13.5%) patients.
Conclusions: Minimally invasive OLIF at L4-5 vertebral segment is a safe and effective technique in terms of clinical and radiological outcomes with low risk of peri-operative and rare permanent complications.
Patient Care: My research is the first report of OLIF L45 in terms of complications and subsidence.
Learning Objectives: To know the early clinical outcomes and perioperative complications related with lumbar plexopathy.