A recent study of older patients with lumbar spinal stenosis found that oblique lateral interbody fusion may lead to better surgical outcomes compared with transforaminal lumbar interbody fusion.
Researchers followed 120 patients over 65 years who underwent surgery for L4-5 spinal stenosis between July 2022 and July 2023. The patients were divided evenly into oblique lateral interbody fusion (OLIF) and transforaminal lumbar interbody fusion (TLIF) groups and received care under the Enhanced Recovery After Surgery (ERAS) protocol, which included early feeding, early ambulation, and reduced use of catheters and drains.
The patients in the OLIF group had shorter hospital stays, averaging 3.5 days compared with 6.8 days in the TLIF group. They also ambulated earlier (1.8 vs 3.4 days), had shorter drain placement (3.4 vs 4.7 days), and less urinary catheter retention (2.7 vs 3.9 days).
Postoperative complications were lower in the OLIF group. Deep vein thrombosis occurred in 1.7% of the patients who underwent OLIF vs 13.3% of those who underwent TLIF. Urinary tract infections (3.3% vs 18.3%), pulmonary infections (3.3% vs 16.6%), and nausea or vomiting (5.0% vs 18.3%) were also less frequent. Transient leg weakness and numbness occurred more often in the TLIF group.
Pain and disability were assessed using the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) prior to surgery, following surgery, and at 1 year. Both groups showed improvement, but a higher proportion of the patients in the OLIF group achieved clinically meaningful improvements in disability at 1 year (93.3% vs 80.0%).
Imaging results favored OLIF, with greater increases in posterior disc height and lumbar lordosis, and a more pronounced reduction in sagittal vertical axis at 1 year, indicating improved spinal alignment.
Although there were no statistically significant differences in intraoperative blood loss, the TLIF group required more postoperative blood (10.0% vs 37.7%) and albumin transfusions (16.7% vs 41.7%). The researchers noted this could reflect greater surgical trauma in TLIF or underreported blood loss in OLIF.
They concluded that OLIF could offer several perioperative advantages in older patients undergoing single-level lumbar fusion. However, it may not be appropriate in patients with complex spinal anatomy or vascular constraints, where TLIF may remain preferable.
Despite limitations such as the single-center design and modest sample size, the findings supported the consideration of OLIF as a favorable option for eligible older patients with L4-5 spinal stenosis. The researchers recommended larger multicenter studies to validate these results and assess broader applications.
The authors declared no competing interests.
Source: BMC Surgery
