Luca Ambrosio, Sathish Muthu, Samuel K. Cho, Micheal S. Virk, Juan P. Cabrera, Patrick C. Hsieh, Andreas K. Demetriades, Stipe Ćorluka, S. Tim Yoon, Gianluca Vadalà, AO Spine Knowledge Forum Degenerative
Neurospine 2025;22(1):40-47. Published online March 31, 2025
Objective This study aims to assess global trends in the use of open surgery versus minimally invasive surgery (MIS) for the treatment of single-level L4–5 degenerative lumbar spondylolisthesis (DLS).
Methods A cross-sectional online survey issued by the AO Spine Knowledge Forum Degenerative was conducted among AO Spine members between July and September 2023. Participants were presented with 3 clinical cases of L4–5 grade 1 DLS, each with varying degrees of stenosis and instability. The survey captured surgeon demographics and preferences for open versus MIS approaches. Statistical analysis, including chi-square tests and logistic regression, was performed to explore associations between surgical choices and surgeon demographics.
Results A total of 943 surgeons responded, with 479 completing the survey. Open surgery was the preferred approach in all 3 cases (58.8%, 57.3%, and 42.4%, respectively), particularly in cases involving central and bilateral foraminal stenosis. MIS was the second most common choice, particularly for unilateral foraminal stenosis with mild instability (38.8%). Surgeons’ preferences varied significantly by region, age, and fellowship training, with younger and fellowship-trained surgeons more likely to prefer MIS.
Conclusion The study highlights the continued predominance of open surgery for DLS, especially in complex cases, despite the growing acceptance of MIS. Significant regional and demographic variations in surgical preferences suggest the need for tailored guidelines and standardized training protocols to optimize patient outcomes. Future research should focus on the long-term efficacy of these approaches and the impact of evolving technologies on surgical decision-making.
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Minimally Invasive Options for Spondylolisthesis Chibuikem A. Ikwuegbuenyi, Mousa Hamad, Ibrahim Hussain, Roger Härtl Neurosurgery Clinics of North America.2026; 37(1): 39. CrossRef
Long-term comparative study of Open-TLIF, MIS-TLIF, and UBE-TLIF in single-level degenerative lumbar spondylolisthesis Jian Luo, Lihua Shen, Changshen Bao, Zhichao Gao European Journal of Medical Research.2026;[Epub] CrossRef
Current Trends and Future Directions in Lumbar Spine Surgery: A Review of Emerging Techniques and Evolving Management Paradigms Gianluca Galieri, Vittorio Orlando, Roberto Altieri, Manlio Barbarisi, Alessandro Olivi, Giovanni Sabatino, Giuseppe La Rocca Journal of Clinical Medicine.2025; 14(10): 3390. CrossRef
Objective This study compared the radiological and clinical outcomes with transforaminal lumbar interbody fusion (TLIF) to evaluate the effect of indirect decompression through oblique lumbar interbody fusion (OLIF) as revision surgery.
Methods We enrolled patients who underwent single-level fusion with revision surgery at the same level as the previous decompression level. We retrospectively reviewed 25 patients who underwent OLIF from 2017 to 2018 and 25 who received TLIF from 2014 to 2018. Radiologic and clinical outcomes were evaluated by cross-sectional area (CSA) of the spinal canal, thickness and area of ligamentum flavum (LF), subsidence, disc height, fusion rate, Oswestry Disability Index (ODI), and visual analogue scale (VAS).
Results Compared with OLIF, the thickness and area of the LF after surgery were significantly less in TLIF, and the resulting CSA extension was also significantly higher. However, both groups showed improvement in ODI and VAS after surgery, and there was no difference between the groups. Complications related to the posterior approach in TLIF were 4 cases, and in OLIF, there were 2 cases that underwent additional posterior decompression surgery and 6 cases of transient paresthesia.
Conclusion Since complications associated with the posterior approach can be avoided, OLIF is a safer and useful minimally invasive surgery. Therefore, appropriate indications are applied, OLIF is a good alternative to TLIF when revision surgery is considered.
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Objective No consensus criteria have been established regarding ideal candidates for indirect decompression with lateral lumbar interbody fusion (LLIF), and contributing factors of indirect decompression failure were rarely reported. We aim to investigate the success rate of indirect decompression by LLIF with proposed selection criteria and identify risk factors associated with indirect decompression failure, defined as persistent pain requiring revision with direct decompression.
Methods Data from 191 patients undergoing LLIF were retrospectively reviewed. All the following criteria must be fulfilled: (1) dynamic clinical symptoms (pain relief in supine position), (2) presence of reducible disc height (recovered disc height in supine position), (3) no profound weakness, and (4) no static stenosis. The success rate of indirect decompression with LLIF and results after at least 1 year of follow-up were collected. Preoperative, procedure-related, and postoperative factors were assessed for their relationship with failure.
Results Of 191 patients,13 patients (6.8%) required additional direct decompression due to persistent pain, giving a criteria success rate of 93.2%. Factors associated with indirect decompression failure included low bone mineral density (T-score < 2.1), low reducible disc height (<13%), low postoperative disc height (< 10 mm), high-grade cage subsidence, and use of plate fixation.
Conclusion We proposed patient selection criteria for indirect decompression with LLIF which had a satisfactory success rate and identified factors associated with the need for additional direct decompression. Our proposed criteria may assist selection of patients likely to achieve good results following indirect decompression with LLIF, and optimize selection based on risk factors of failure.
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Objective Oblique lumbar interbody fusion (OLIF) involves inserting large cages into the interbody disc space. This expands the spinal canal and neural foramen by stretching the ligament flavum and releasing the facet joint, resulting in indirect neural decompression. Our objective was to investigate the changes in the spinal canal and ligament flavum over time after OLIF.
Methods This was a prospective observational study involving 30 patients who underwent OLIF L4–5 between 2015 and 2018. In total, 27 of the 30 patients underwent preoperative, early follow-up ( < 5 days), and late follow-up (10–14 months) magnetic resonance imaging to measure the area of the spinal canal and ligament flavum. Based on the results, the patients were divided into subsidence and nonsubsidence groups for further analysis.
Results After OLIF, the spinal canal area gradually increased during the preoperative, early postoperative, and late postoperative periods (p < 0.001). The thickness and area of the ligament flavum decreased gradually over the same periods (p < 0.001). Low-grade subsidence (2–4.4 mm) did not influence the effects on the spinal canal and ligament.
Conclusion After OLIF, the spinal canal and ligament flavum gradually change, which is effective for indirect neural decompression. In addition, the effects of low-grade subsidence on the remodeling of the spinal canal and ligament flavum are insignificant.
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Improved intervertebral fusion in LLIF rabbit model with a novel titanium cage Jiaqi Li, Bingyi Zhao, Weijian Wang, Yafei Xu, Haoyu Wu, Wei Zhang The Spine Journal.2024; 24(6): 1109. CrossRef
A Comprehensive Analysis of Potential Complications after Oblique Lumbar Interbody Fusion : A Review of Postoperative Magnetic Resonance Scans in Over 400 Cases Kang-Hoon Lee, Su-Hun Lee, Jun-Seok Lee, Young-Ha Kim, Soon-Ki Sung, Dong-Wuk Son, Sang-Weon Lee, Geun-Sung Song Journal of Korean Neurosurgical Society.2024; 67(5): 550. CrossRef
Intraoperative Facet Joint Block Reduces Pain After Oblique Lumbar Interbody Fusion Sung Hyeon Noh, Sang-Woo Lee, Jong-moon Hwang, JinWoo Jung, Eunyoung Lee, Dae-Chul Cho, Chi Heon Kim, Kyoung-Tae Kim Journal of Bone and Joint Surgery.2024;[Epub] CrossRef
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Surgical treatment of spondylolisthesis by oblique lumbar interbody fusion and transpedicular screw fixation: Comparison between conventional double position versus navigation-assisted single lateral position Junghoon Han, Chang-Min Ha, Woon Tak Yuh, Young San Ko, Jun-Hoe Kim, Tae-Shin Kim, Chang-Hyun Lee, Sungjoon Lee, Sun-Ho Lee, Asfandyar Khan, Chun Kee Chung, Chi Heon Kim, Mohamed El-Sayed Abdel-Wanis PLOS ONE.2023; 18(9): e0291114. CrossRef
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