Weerasak Singhatanadgige, Thanadol Tangdamrongtham, Worawat Limthongkul, Wicharn Yingsakmongkol, Stephen J. Kerr, Teerachat Tanasansomboon, Vit Kotheeranurak
Neurospine 2024;21(3):820-832. Published online September 30, 2024
Objective Oblique lumbar interbody fusion (OLIF), performed using a retroperitoneal approach, can lead to complications related to the approach, such as lumbar sympathetic chain injury (LSCI). Although LSCI is a common complication of OLIF, its reported incidence varies across studies due to an absence of specific diagnostic criteria. Moreover, research on the risk factors of postoperative sympathetic chain injuries after OLIF remains limited. Therefore, this study aimed to describe the incidence, and identify independent risk factors for LSCI, in patients with degenerative lumbar spinal diseases who underwent OLIF.
Methods Between October 2020 and August 2023, a retrospective review was conducted at our institute on 200 patients who underwent OLIF at 1 to 4 consecutive spinal levels (L1–5) for degenerative spinal diseases including spinal stenosis, spondylolisthesis, degenerative scoliosis. We excluded those with infections, trauma, tumors, and lower extremity edema/warmth due to other causes. The patients were categorized into 2 groups: those with and without LSCI symptoms. Demographic data, operative data, and pre- and postoperative parameters were evaluated for their association with LSCI using a univariate logistic regression model. Variables with a p-value <0.1 in the univariate analysis were included in a multivariate model to identify the independent risk factors.
Results Thirty-five of 200 patients (17.5%) developed LSCI symptoms after OLIF. Multivariate logistic regression analysis indicated that prolonged retraction time, particularly exceeding 31.5 miniutes, remained an independent risk factor (adjusted odds ratio, 12.59; p<0.001).
Conclusion This study demonstrated that prolonged retraction time was an independent risk factor for LSCI following OLIF, particularly when it exceeded 31.5 minutes. Protecting the lumbar sympathetic chain during surgery and minimizing retraction time are crucial to avoiding LSCI following OLIF.
Citations
Citations to this article as recorded by
Chirurgisches Management benigner paravertebraler Tumoren – Fallserie und Literaturübersicht Moritz Thiel, Osama Ali, Karsten Wiebe, Walter Stummer, Michael Schwake Zentralblatt für Chirurgie - Zeitschrift für Allgemeine, Viszeral-, Thorax- und Gefäßchirurgie.2026; 151(03): 300. CrossRef
Technical Feasibility and Early Outcomes of Minimally Invasive Transforaminal Lumbar Interbody Fusion with Large-Footprint Cage via Tubular Approach: A Novel Surgical Technique Ayush Sharma, Shubham Kadam, Nandan Marathe, Avi Rangala, Sourav L. Das, Ajit Rampure Asian Journal of Neurosurgery.2026;[Epub] CrossRef
Association of weight change with cardiovascular events and all-cause mortality in obese participants with cardiovascular disease: a prospective cohort study Jufen Zhang, Rudolph Schutte, Barbara Pierscionek Heart.2025; 111(10): 454. CrossRef
Incidence and Risk Factors of Postoperative Ileus in Oblique Lumbar Interbody Fusion Surgery: A Retrospective Study Young-Seok Lee, Myeong Jin Ko, Seung Won Park Neurospine.2025; 22(1): 222. CrossRef
Complications of anterior-to-psoas and their avoidance and treatment Chang Hwa Ham, Woo-Keun Kwon, Joo Han Kim Seminars in Spine Surgery.2025; 37(1): 101161. CrossRef
Worawat Limthongkul, Bandid Chaiwongwattana, Stephen J. Kerr, Teerachat Tanasansomboon, Vit Kotheeranurak, Wicharn Yingsakmongkol, Weerasak Singhatanadgige
Neurospine 2024;21(3):845-855. Published online September 30, 2024
Objective Oblique lateral interbody fusion (OLIF) is a minimally invasive procedure for stabilizing the spine and indirectly decompressing the neural elements. There is sparse data on unsatisfactory outcomes that require additional interventions (surgery or intervention) after OLIF. This study aimed to identify the causes, and risk factors of these reintervention.
Methods This was a single-center retrospective study of the patients who underwent the OLIF procedure from June 2016 to March 2023. Several clinical and radiographic parameters were studied. We also analyzed associations between several potential risk factors and the reintervention following OLIF.
Results A total of 231 patients were included. Over an average of 2.5 years of follow-up, 28 patients (12.1%) required a reintervention. Adjacent segment disease (ASD) was the most common cause of reintervention. The risk factors associated with reintervention were previous surgery (adjusted odds ratio [aOR], 4.44; 95% confidence interval [CI], 1.21–16.33; p=0.02) and high preoperative Oswestry Disability Index (ODI) scores (aOR, 1.04; 95% CI, 1.00–1.08; p=0.03). Although increasing the duration of follow-up was not statistically significant, the 95% CI was consistent with an increased risk of reintervention with longer follow-up (OR, 1.18; 95% CI, 0.94–1.50).
Conclusion This study showed that patients with prior lumbar surgery and high preoperative ODI scores were more likely to require additional intervention after the OLIF procedure. In addition, an increasing duration of follow-up was associated with an increased risk of reintervention. The most common reason for reintervention was ASD after OLIF.
Citations
Citations to this article as recorded by
The iLLIF score: a predictive success scoring system for indirect decompression in lateral lumbar interbody fusion Wicharn Yingsakmongkol, Narat Virojanawat, Khanathip Jitpakdee, Surachat Jaroenwareekul, Worawat Limthongkul, Vit Kotheeranurak, Weerasak Singhatanadgige European Spine Journal.2026;[Epub] CrossRef
Three Cases of Indirect Decompression Failure Following Oblique Lumbar Interbody Fusion Requiring Early Direct Posterior Decompression: Analysis of Etiologies and Literature Review Satoshi Hattori, Satoru Matsutani Cureus.2025;[Epub] CrossRef
Objective To compare the clinical and radiographic outcomes following lateral lumbar interbody fusion (LLIF) between direct and indirect decompression in the treatment of patients with degenerative lumbar diseases.
Methods Patients who underwent single-level LLIF were randomized into 2 groups: direct decompression (group D) and indirect decompression (group I). Clinical outcomes including the Oswestry Disability index and visual analogue scale of back and leg pain were collected. Radiographic outcomes including cross-sectional area (CSA) of thecal sac, disc height, foraminal height, foraminal area, fusion rate, segmental, and lumbar lordosis were measured.
Results Twenty-eight patients who met the inclusion criteria were eligible for the analysis, with a distribution of 14 subjects in each group. The average age was 66.1 years. Postoperatively, significant improvements were observed in all clinical parameters. However, these improvements did not show significant difference between both groups at all follow-up periods. All radiographic outcomes were not different between both groups, except for the increase in CSA which was significantly greater in group D (77.73 ± 20.26 mm2 vs. 54.32 ± 35.70 mm2, p = 0.042). Group I demonstrated significantly lower blood loss (68.13 ± 32.06 mL vs. 210.00 ± 110.05 mL, p < 0.005), as well as shorter operative time (136.35 ± 28.07 minutes vs. 182.18 ± 42.67 minutes, p = 0.002). Overall complication rate was not different.
Conclusion Indirect decompression through LLIF results in comparable clinical improvement to LLIF with additional direct decompression over 1-year follow-up period. These findings suggest that, for an appropriate candidate, direct decompression in LLIF might not be necessary since the ligamentotaxis effect achieved through indirect decompression appears sufficient to relieve symptoms while diminishing blood loss and operative time.
Citations
Citations to this article as recorded by
Is Congenital Lumbar Spinal Canal Stenosis a Contraindication for Indirect Decompression by Lateral Lumbar Interbody Fusion (LLIF)? Weerasak Singhatanadgige, Thada Nashinoros, Teerachat Tanasansomboon, Wicharn Yingsakmongkol, Vit Kotheeranurak, Worawat Limthongkul Global Spine Journal.2026; 16(5): 2117. CrossRef
The Role of Hounsfield Units in Predicting Cage Subsidence After Lateral Lumbar Interbody Fusion: A Systematic Review and Meta-Analysis Chen Zhang, Zachary Chu, Jonathan Boey, Reuben Chee Cheong Soh World Neurosurgery.2026; 208: 124836. CrossRef
Mid-term effects of posterior versus oblique lumbar interbody fusion on spinopelvic alignment and clinical outcomes in lumbar spinal stenosis: a retrospective comparative cohort study Haixu Wang, Wei Du, Li Zhang, Xiaoping Wang, Rong Chen, Lanchun Ren, Yue Zheng, Zhe Lin, Zhiyong Hou Journal of Orthopaedic Surgery and Research.2026;[Epub] CrossRef
The iLLIF score: a predictive success scoring system for indirect decompression in lateral lumbar interbody fusion Wicharn Yingsakmongkol, Narat Virojanawat, Khanathip Jitpakdee, Surachat Jaroenwareekul, Worawat Limthongkul, Vit Kotheeranurak, Weerasak Singhatanadgige European Spine Journal.2026;[Epub] CrossRef
Factors affecting outcomes of indirect decompression after oblique and lateral lumbar interbody fusions Kyle M M Behrens, Hossein Elgafy World Journal of Orthopedics.2025;[Epub] CrossRef
A systematic review of biportal endoscopic spinal surgery with interbody fusion Wongthawat Liawrungrueang, Ho-Jin Lee, Sang Bum Kim, Sang-Min Park, Watcharaporn Cholamjiak, Hyun-Jin Park Asian Spine Journal.2025; 19(2): 275. CrossRef
Objective We introduced a new preoperative method, the “expanded surgical corridor,” to evaluate the actual safety corridor, which may expand the possibility of performing oblique lateral interbody fusion (OLIF).
Methods Axial T2-weighted magnetic resonance images at the L4–5 disc level of 511 lumbar degenerative disease patients was evaluated. The distance between the medial edge of the left-sided psoas muscle and the major artery was measured as the conventional surgical corridor (CSc). The distance between the major vein and lumbar plexus was measured as the expanded surgical corridor (ESc).
Results The mean CSc and ESc were 13.9 ± 8.20 and 37.43 ± 10.1 mm, respectively. No surgical corridor was found in 7.05% of CSc and 1.76% of ESc, small corridor ( ≤ 1 cm) was found in 27.40% of CSc and 0.59% of ESc, moderate corridor (1–2 cm) was found in 42.07% of CSc and 1.96% of ESc, and large corridor ( > 2 cm) was found in 23.48% of CSc and 95.69% of ESc. A total of 33.83% (45 of 133) of whom were preoperatively categorized as having a limited surgical corridor by conventional measurement, underwent OLIF L4–5 successfully.
Conclusion By using the ESc, only 2.35% were categorized as having a limited surgical corridor. The other 97.65% of the patients had an approachable corridor that could be successfully operated by experienced spine surgeons who employ meticulous surgical dissection and thorough understanding of the anatomical structures. The ESc may represent true accessibility to the disc space for OLIF, particularly at the L4–5 level.
Advantages of a new improved oblique Retractor in oblique lateral lumbar interbody fusion: a retrospective study Jun Mo, Siping Zhang, Zhanjun Ma, Jianjiang Li, Yifei Huang Journal of Orthopaedic Surgery and Research.2025;[Epub] CrossRef
Ibero-Latin American Consensus on Oblique Lumbar Interbody Fusion (L2-L5): A Modified Delphi Study Federico Landriel, Alderico Girão Campos de Barros, Rubén Alejandro Morales Ciancio, Alfonso Vega, Alisson R. Teles, Álvaro Silva González, Carlos Abraham Arellanes-Chávez, David Suárez-Fernández, Gerd Bordon, Javier Gutierrez, José Augusto Malheiros, Jua World Neurosurgery.2025; 203: 124490. CrossRef
Comparison of midterm outcomes between biportal endoscopic transforaminal lumbar interbody fusion and oblique lumbar interbody fusion with lateral vertebral body screw fixation for single level spondylolisthesis Fu-Cheng Kao, Shih-Feng Hung, Yu-Pao Hsu, Tsung-Ting Tsai, Hung-Kang Wu, Ming-Te Cheng, Kuang-Kai Hsueh, Po-Yuan Lin, Ching-Hsiao Yu BMC Musculoskeletal Disorders.2025;[Epub] CrossRef
Psoas Muscle Morphology Arash Emami, George Abdelmalek, Iciar Davila, Stuart Changoor, Neil Patel, Daniel Coban, Nikhil Sahai, Kumar Sinha, Ki Hwang Spine.2024; 49(24): E418. CrossRef
First
Prev
