Objective To quantify the effect of different hip positions on lumbar lordosis (LL) and spinopelvic parameters in the right lateral decubitus position (RLDP) and identify the configuration that most closely replicates physiologic standing alignment during lateral lumbar interbody fusion in minimally invasive spinal surgery.
Methods Thirty healthy volunteers (15 males, 15 females; mean age, 27.8±8.6 years) underwent lateral lumbar radiographs in standing position and 5 RLDP configurations: neutral hips (NN), 30° flexion of both hips (30FF), 30° flexion of the right hip with left hip neutral (30FN), 60° flexion of both hips (60FF), and 60° flexion of the right hip with left hip neutral (60FN). LL, pelvic tilt (PT), sacral slope (SS), and pelvic incidence (PI) were measured. Each position was compared to standing using paired t-tests. Intra- and interobserver reliability were evaluated using intraclass correlation coefficients (ICCs).
Results LL decreased significantly in all RLDP positions compared with standing (51.1°±3.8°). The 30FN position showed the smallest change (ΔLL=-4.9°, p<0.001), whereas 60FF showed the greatest (ΔLL=-15.0°, p<0.001). In 30FN, PT decreased (p=0.013) and SS increased (p=0.003), indicating mild anterior pelvic rotation. PI showed minimal variation across positions. Intra- and interobserver ICCs ranged from 0.92 to 0.99, confirming high measurement reliability.
Conclusion Hip position significantly influences lumbar and pelvic alignment in RLDP. Among tested configurations, the 30FN position (right hip flexed 30°, left neutral) showed the smallest numerical deviation from standing alignment and spinopelvic harmony relative to standing in RLDP.
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
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
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
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.2025;[Epub] CrossRef
Ishan Khosla, Fatima N. Anwar, Andrea M. Roca, Srinath S. Medakkar, Alexandra C. Loya, Keith R. MacGregor, Omolabake O. Oyetayo, Eileen Zheng, Aayush Kaul, Jacob C. Wolf, Vincent P. Federico, Gregory D. Lopez, Arash J. Sayari, Kern Singh
Neurospine 2024;21(1):361-371. Published online January 29, 2024
Objective To evaluate the effect of Veterans RAND 12-item health survey mental composite score (VR-12 MCS) on postoperative patient-reported outcome measures (PROMs) after undergoing lateral lumbar interbody fusion.
Methods Retrospective data from a single-surgeon database created 2 cohorts: patients with VR-12 MCS ≥ 50 or VR-12 MCS < 50. Preoperative, 6-week, and final follow-up (FF)- PROMs including VR-12 MCS/physical composite score (PCS), 12-item Short Form health survey (SF-12) MCS/PCS, Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), Patient Health Questionnaire-9 (PHQ-9), visual analogue scale (VAS)-back/leg pain (VAS-BP/LP), and Oswestry Disability Index (ODI) were collected. ∆6-week and ∆FF-PROMs were calculated. Minimal clinically important difference (MCID) achievement rates were determined from established cutoffs from the literature. For intercohort comparison, chi-square analysis was used for categorical variables, and Student t-test for continuous variables.
Results Seventy-nine patients were included; 25 were in VR-12 MCS < 50. Mean postoperative follow-up time was 17.12 ± 8.43 months. The VR-12 MCS < 50 cohort had worse VR-12 PCS, SF-12 MCS, PROMIS-PF, PHQ-9, VAS-BP, and ODI scores preoperatively (p ≤ 0.014, all), worse VR-12 MCS/PCS, SF-12 MCS, PROMIS-PF, PHQ-9, and ODI scores at 6-week postoperatively (p ≤ 0.039, all), and worse VR-12 MCS, SF-12 MCS, PROMIS-PF, PHQ-9, VAS-BP, VAS-LP, and ODI scores at FF (p ≤ 0.046, all). The VR-12 MCS < 50 cohort showed greater improvement in VR-12 MCS and SF-12 MCS scores at 6 weeks and FF (p ≤ 0.005, all). The VR-12 MCS < 50 cohort experienced greater MCID achievement for VR-12 MCS, SF-12 MCS, and PHQ-9 (p ≤ 0.006, all).
Conclusion VR-12 MCS < 50 yielded worse mental health, physical function, pain and disability postoperatively, yet reported greater improvements in magnitude and MCID achievement for mental health.
Citations
Citations to this article as recorded by
Preoperative mental health status measured by the SF12 questionnaire correlates with patient reported outcomes one year after total knee arthroplasty Jordi Faig-Martí, Robert Ferrer-Rivero, Adriana Martínez-Catasús Journal of Orthopaedic Reports.2025; : 100852. 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
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.
Citations
Citations to this article as recorded by
Oblique Lateral Interbody Fusion With Lateral Vertebral Screw Fixation Versus Transforaminal Lumbar Interbody Fusion for Severe Lumbar Stenosis: Results of a Multicenter Randomized Controlled Trial Xuefeng Li, Cheng Lin, Tangyiheng Chen, Renjie Li, Dapeng Li, Sheng Song, Huilin Yang, Genlei Chu, Weimin Jiang, Yijie Liu Neurosurgery.2026;[Epub] CrossRef
Lumbar Foraminal Morphology Can Affect Outcomes of Indirect Decompression: A Systematic Review and Novel Classification Rakan Bokhari, Mohamad Bakhaidar, Abdulrahman Alnaseem, Khalid Bajunaid, Omar Aljohani, Mohamed Alwadai, Saman Shabani, Rodrigo Navarro-Ramirez, Christoph P. Hofstetter, Muhammad Abd-El-Barr Global Spine Journal.2026;[Epub] CrossRef
Global research landscape and citation dynamics of oblique lumbar interbody fusion (OLIF): A bibliometric analysis of the 100 most influential articles Badr Hafiz, Thamer Alsharif, Faisal Sukkar, Moaath Alghamdi, Ali Zaki Alhabib, Shuruq Obaid Alshammari, Saleh Baeesa Brain and Spine.2026; 6: 106043. CrossRef
Static Versus Expandable Cages in Minimally Invasive Lateral Lumbar Interbody Fusion Ryan S. Beyer, Tara Shooshani, Bianca Batista, Genevieve M. Fraipont, Omead Pooladzandi, Nolan J. Brown, Zach Pennington, Martin H. Pham Clinical Spine Surgery.2025; 38(7): 326. 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
Patient selection and workup David Strong, Joel Steiner, Robert Lee Seminars in Spine Surgery.2025; 37(1): 101158. CrossRef
Ligamentotaxis Effect of Lateral Lumber Interbody Fusion and Cage Subsidence Ryosuke Tomio Journal of Clinical Medicine.2025; 14(13): 4554. CrossRef
Pearls and Pitfalls of Revision Unilateral Biportal Endoscopic Lumbar Spine Surgery: A Technical Note Jiawen Fong, Zi Xian Justin Chou, Walter-Soon-Yaw Wong, Yilun Huang Cureus.2025;[Epub] CrossRef
Effect of microscope-assisted modified lateral lumbar interbody fusion and impact on lumbar lordosis and intervertebral height Weijian Wang, Jilong An, Jiaqi Li, Han Wu, Haoyu Wu, Yapeng Sun, Wei Zhang BMC Musculoskeletal Disorders.2025;[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
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
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.2025;[Epub] CrossRef
Prediction of Angle Loss after L4/5 Oblique Lumbar Interbody Fusion : Development of a Risk Stratification Model Se-Woon Kim, Su-Hun Lee, Jun-Seok Lee, Chi-Hyung Lee, Chang-Hyun Kim, Soon-Ki Sung, Dong-Wuk Son, Sang-Weon Lee Journal of Korean Neurosurgical Society.2025; 68(6): 724. CrossRef
Efficacy observation of oblique lateral interbody fusion (OLIF) in treating severe spinal stenosis Yiliya Yilihamu, Jun Mo, Zhanjun Ma, Jianjiang Li, Yifei Huang BMC Surgery.2025;[Epub] CrossRef
Is Direct Decompression Necessary for Lateral Lumbar Interbody Fusion (LLIF)? A Randomized Controlled Trial Comparing Direct and Indirect Decompression With LLIF in Selected Patients Worawat Limthongkul, Chayapong Thanapura, Khanathip Jitpakdee, Pakawas Praisarnti, Vit Kotheeranurak, Wicharn Yingsakmongkol, Teerachat Tanasansomboon, Weerasak Singhatanadgige Neurospine.2024; 21(1): 342. CrossRef
Impact of Osteoporosis on Short-Term Surgical Outcomes in Lumbar Degenerative Disease Patients Undergoing Lateral Lumbar Interbody Fusion: A Retrospective Analysis Akihiko Hiyama, Daisuke Sakai, Hiroyuki Katoh, Masato Sato, Masahiko Watanabe World Neurosurgery.2024; 188: e424. CrossRef
Oblique Lumbar Interbody Fusion Combined with Posterior Percutaneous Pedicle Screw Internal Fixation: Does Variability in Cage Position Influence Clinical Outcomes? Xingda Chen, Liekun Chen, Jingjing Tang, Wanyan Chen, Zefeng Song, Zelin Zhou, Hang Zhuo, Riwei Tan, Rueishiuan Jiang, Wenhua Zhao, De Liang, Hui Ren, Gengyang Shen, Xiaobing Jiang World Neurosurgery.2024; 189: e904. 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
Risk Factors of Unsatisfactory Outcomes Requiring Additional Intervention Following Oblique Lateral Interbody Fusion Worawat Limthongkul, Bandid Chaiwongwattana, Stephen J. Kerr, Teerachat Tanasansomboon, Vit Kotheeranurak, Wicharn Yingsakmongkol, Weerasak Singhatanadgige Neurospine.2024; 21(3): 845. CrossRef
Postoperative urinary retention after oblique lumbar interbody fusion under the systematic management protocol Joonsoo Lim, Jangyeob Lim, Asfandyar Khan, Chang-Hyun Lee, Jun-Hoe Kim, Sejin Choi, Tae-Shin Kim, Yunhee Choi, Chun Kee Chung, Sangwook T. Yoon, Kyoung-Tae Kim, Chi Heon Kim Scientific Reports.2024;[Epub] CrossRef
Percutaneous transforaminal endoscopic surgery combined with mini-incision OLIF and anterolateral screws rod fixation vs. MIS-TLIF for surgical treatment of single-level lumbar spondylolisthesis Tianyao Zhou, Wenshuai Fan, Yutong Gu, Wu Che, Liang Zhang, Yichao Wang Frontiers in Surgery.2023;[Epub] CrossRef
Hybrid surgery of percutaneous transforaminal endoscopic surgery (PTES) combined with OLIF and anterolateral screws rod fixation for treatment of multi-level lumbar degenerative diseases with intervertebral instability Tianyao Zhou, Yutong Gu Journal of Orthopaedic Surgery and Research.2023;[Epub] CrossRef
Comparing Efficacy of Lumbar Disc Space Preparation via an Anterior-to-Psoas Approach Between Intraoperative Conventional Fluoroscopy and Computed Tomographic-Based Navigation System: A Cadaveric Study Worawat Limthongkul, Waranyoo Wathanavasin, Vit Kotheeranurak, Thanadol Tangdamrongtham, Teerachat Tanasansomboon, Wicharn Yingsakmongkol, Weerasak Singhatanadgige World Neurosurgery.2023; 176: e226. CrossRef
Mini-Open Intercostal Retroperitoneal Approach for Upper Lumbar Spine Lateral Interbody Fusion Su Hun Lee, Dong Wuk Son, Sung Hyun Bae, Jun Seok Lee, Young Ha Kim, Soon Ki Sung, Sang Weon Lee, Geun Sung Song Neurospine.2023; 20(2): 553. CrossRef
Effective Modulation of Inflammation and Oxidative Stress for Enhanced Regeneration of Intervertebral Discs Using 3D Porous Hybrid Protein Nanoscaffold Letao Yang, Basanta Bhujel, Yannan Hou, Jeffrey Luo, Seong Bae An, Inbo Han, Ki‐Bum Lee Advanced Materials.2023;[Epub] CrossRef
Letter to the Editor : Classifying the Anatomical Location of the Ureter after Retroperitoneal Dissection Su-Hun Lee, Dong-Wuk Son, Jun-Seok Lee, Geun-Sung Song Journal of Korean Neurosurgical Society.2023; 66(5): 605. CrossRef
Simultaneous Single-Position Lateral Lumbar Interbody Fusion Surgery and Unilateral Percutaneous Pedicle Screw Fixation for Spondylolisthesis Hui Lv, Yu Sheng Yang, Jian Hong Zhou, Yuan Guo, Hui Chen, Fei Luo, Jian Zhong Xu, Zhong Rong Zhang, Ze Hua Zhang Neurospine.2023; 20(3): 824. CrossRef
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
Enhanced Intervertebral Disc Repair via Genetically Engineered Mesenchymal Stem Cells with Tetracycline Regulatory System Yeji Kim, Seong Bae An, Sang-Hyuk Lee, Jong Joo Lee, Sung Bum Kim, Jae-Cheul Ahn, Dong-Youn Hwang, Inbo Han International Journal of Molecular Sciences.2023; 24(22): 16024. CrossRef
Safety and Feasibility of Intradiscal Administration of Matrilin-3-Primed Adipose-Derived Mesenchymal Stromal Cell Spheroids for Chronic Discogenic Low Back Pain: Phase 1 Clinical Trial Dong Hyun Lee, Kwang-Sook Park, Hae Eun Shin, Sung Bum Kim, Hyejeong Choi, Seong Bae An, Hyemin Choi, Joo Pyung Kim, Inbo Han International Journal of Molecular Sciences.2023; 24(23): 16827. CrossRef
An Expanded Surgical Corridor of Oblique Lateral Interbody Fusion at L4–5: A Magnetic Resonance Imaging Study Worawat Limthongkul, Pakawas Praisarnti, Teerachat Tanasansomboon, Natavut Prasertkul, Vit Kotheeranurak, Wicharn Yingsakmongkol, Weerasak Singhatanadgige Neurospine.2023; 20(4): 1450. CrossRef
Objective To review the evidence for the use of electromyography (EMG), motor-evoked potentials (MEPs), and somatosensory-evoked potentials (SSEPs) intraoperative neuromonitoring (IONM) strategies during lateral lumbar interbody fusion (LLIF), as well as discuss the limitations associated with each technique.
Methods A comprehensive review of the literature and compilation of findings relating to clinical studies investigating the efficacy of EMG, MEP, SSEP, or combined IONM strategies during LLIF.
Results The evidence for the use of EMG is mixed with some studies demonstrating the efficacy of EMG in preventing postoperative neurologic injuries and other studies demonstrating a high rate of postoperative neurologic deficits with EMG monitoring. Multimodal IONM strategies utilizing MEPs or saphenous SSEPs to monitor the lumbar plexus may be promising strategies based on results from a limited number of studies.
Conclusion The use of traditional EMG during LLIF remains without consensus. There is a growing body of evidence utilizing multimodal IONM with MEPs or saphenous SSEPs demonstrating a possible decrease in postoperative neurologic injuries after LLIF. Future prospective studies, with clear definitions of neurologic injury, that evaluate different multimodal IONM strategies are needed to better assess the efficacy of IONM during LLIF.
Citations
Citations to this article as recorded by
Lateral Lumbar Interbody Fusion: An Update on Motor Deficits in 1000 Patients Across Two Decades Marco D. Burkhard, Charlotte Jones, Simon Ortiz, Torben Stepan, Bryce Demopoulos, Bruno Verna, Ali E. Guven, Anna-Maria Mielke, Jennifer Shue, Federico P. Girardi, Frank P. Cammisa, Andrew A. Sama, Alexander P. Hughes Global Spine Journal.2026;[Epub] CrossRef
Anesthetic Considerations and Management of Spine Surgery Performed Under Neuraxial Anesthesia Marc A. Buren, Hemra Cil Current Anesthesiology Reports.2025;[Epub] CrossRef
Optimizing Single-Position Prone Lateral Lumbar Interbody Fusion with Exoscopic Technology: A Review of Key Innovations Christian Quinones, John Preston Wilson, Deepak Kumbhare, Bharat Guthikonda, Stanley Hoang Journal of Clinical Medicine.2025; 14(4): 1132. CrossRef
Safety and Feasibility of Transabdominal Muscle Action Potential Monitoring in Lateral Lumbar Surgery Kaveh Khajavi, Jim Youssef, Robert K. Eastlack, Jeffrey R. Balzer, Greg Niznik, William Smith World Neurosurgery.2025; 197: 123878. CrossRef
Advanced neuromonitoring in lateral surgery – The role of transabdominal muscle action potential Michael R. McDermott, Alfred-John Bayaton, Dane Wheeler, Ashish Patel Seminars in Spine Surgery.2025; : 101178. CrossRef
Complication avoidance in prone single-position lateral spine surgery: Strategies and best practice Bryan J. Heard, Scott Mallozzi, Michael H Weber, Isaac L. Moss, Hardeep Singh Seminars in Spine Surgery.2025; : 101180. CrossRef
The future of intraoperative neuromonitoring (IONM) in spinal surgery W. Bryan Wilent, Marcia-Ruth Ndege, Adam Doan North American Spine Society Journal (NASSJ).2025; 24: 100777. CrossRef
Single Position Prone Lateral Lumbar Interbody Fusion: A Review of the Current Literature Freddy P. Jacome, Justin J. Lee, David M. Hiltzik, Sia Cho, Manasa Pagadala, Wellington K. Hsu Current Reviews in Musculoskeletal Medicine.2024; 17(9): 386. CrossRef
Management of Refractory Post-operative Osteomyelitis and Discitis: A Case Report Chase A DeLong, Malek Bashti, Long Di, Sumedh S Shah, Emade Jaman, Gregory W Basil Cureus.2024;[Epub] CrossRef
Feasibility of Saphenous Nerve Somatosensory-Evoked Potential Intraoperative Monitoring During Lumbar Spine Surgery Sydney Rucker, Nishtha Singh, Eric Mai, Tomoyuki Asada, Pratyush Shahi, Kristin Mercado, Dora Leung, Sravisht Iyer, Ronald Emerson, Sheeraz A. Qureshi Spine.2024; 49(13): 923. CrossRef
The Improvement of Intraoperative Motor Evoked Potential after Decompression in Cervical Compressive Myelopathy: Its Significance and Related Factors Jong Yun Kwon, Dong Hwan Kim, Kyoung Hyup Nam, Byung Kwan Choi, In Ho Han The Nerve.2024; 10(2): 80. CrossRef
Long-Term Motor versus Sensory Lumbar Plexopathy After Lateral Lumbar Interbody Fusion: Single-Center Experience, Intraoperative Neuromonitoring Results, and Multivariate Analysis of Patient-Level Predictors Bryan Zheng, Owen P. Leary, Robert A. Beer, David D. Liu, Sarah Nuss, Adriel Barrios-Anderson, Spencer Darveau, Sohail Syed, Ziya L. Gokaslan, Albert E. Telfeian, Adetokunbo A. Oyelese, Jared S. Fridley World Neurosurgery.2023; 170: e568. CrossRef
The Prone Lateral Approach for Lumbar Fusion—A Review of the Literature and Case Series Gal Barkay, Ian Wellington, Scott Mallozzi, Hardeep Singh, Isaac L. Moss Medicina.2023; 59(2): 251. CrossRef
Imaging study of the effect of postural changes on the retroperitoneal oblique corridor in degenerative lumbar scoliosis Wei Yang, Zecheng Cai, Xiaoyin Liu, Wenqi Yuan, Rong Ma, Zhen Chen, Jianqun Zhang, Peng Wu, Zhaohui Ge European Spine Journal.2023; 32(10): 3659. CrossRef
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
Three-column reconstruction through the posterior approach alone for the treatment of a severe lumbar burst fracture: a case report Woo Seok Kim, Tae Seok Jeong, Woo Kyung Kim Journal of Trauma and Injury.2023; 36(3): 290. CrossRef
Female Sex and Supine Proximal Lumbar Lordosis Are Associated With the Size of the LLIF “Safe Zone” at L4-L5 Mitchell S. Fourman, Ram K. Alluri, J. Manuel Sarmiento, Keith W. Lyons, Francis C. Lovecchio, Kasra Araghi, Sidhant S. Dalal, Daniel J. Shinn, Junho Song, Pratyush Shahi, Dimitra Melissaridou, John A. Carrino, Evan D. Sheha, Sravisht Iyer, James E. Dowde Spine.2023; 48(22): 1606. CrossRef
Neuromonitoring in Lateral Approaches for Lumbar Interbody Fusion: A Systematic Review James W. Nie, Timothy J. Hartman, Eileen Zheng, Keith R. MacGregor, Omolabake O. Oyetayo, Kern Singh World Neurosurgery.2022; 168: 268. CrossRef
Impact of preoperative symptom duration in patients undergoing lateral lumbar interbody fusion James W. Nie, Timothy J. Hartman, Omolabake O. Oyetayo, Keith R. MacGregor, Eileen Zheng, Alexander W. Parsons, Dustin H. Massel, Arash J. Sarari, Kern Singh Acta Neurochirurgica.2022; 165(1): 89. CrossRef
Histological and Morphometric Changes in the Femoral Nerve During Lateral Interbody Fusion of the Lumbar Spine: Experimental Study Tatiana N. Varsegova, Olga V. Diuriagina, Nikolai I. Antonov, Sergey O. Ryabykh Traumatology and Orthopedics of Russia.2021; 27(4): 82. CrossRef
Objective The oblique lumbar interbody fusion (OLIF) can be done with either fluoroscopy or navigation. However, it is unclear how navigation affects the overall flow of the procedure. We wished to report on the accuracy of this technique using navigation and on how navigation affects surgical time and complications.
Methods A retrospective review was undertaken to evaluate patients who underwent OLIF using spinal navigation at University of California San Francisco. Data collected were demographic variables, perioperative variables, and radiographic images. Postoperative lateral radiographs were analyzed for accuracy of cage placement. The disc space was divided into 4 quadrants from anterior to posterior, zone 1 being anterior, and zone 4 being posterior. The accuracy of cage placement was assessed by placement.
Results There were 214 patients who met the inclusion criteria. A total of 350 levels were instrumented from L1 to L5 using navigation. The mean follow-up time was 17.42 months. The mean surgical time was 211 minutes, and the average surgical time per level was 129.01 minutes. After radiographic analysis, 94.86% of cages were placed within quartiles 1 to 3. One patient (0.47%) underwent revision surgery because of suboptimal cage placement. For approach-related complications, transient neurological symptoms were 10.28%, there was no vascular injury.
Conclusion The use of navigation to perform OLIF from L1 to L5 resulted in a cage placement accuracy rate of 94.86% in 214 patients.
Citations
Citations to this article as recorded by
CT Evaluation of Lumbar Interbody Fusion: A Comprehensive Review with an Integrated Framework for Principle-Based Interpretation Szu-Hsiang Peng, Jwo-Luen Pao Diagnostics.2026; 16(1): 140. CrossRef
Complications With Navigation-Assistance in Thoraco-Lumbar Spine Surgery Takeshi Fujii, Patricia Lipson, Kenneth T. Nguyen, Gianluca Vadalà, Laura Scaramuzzo, Patrick Hsieh, Katie Krause, Sangwook Tim Yoon, Philip K. Louie Global Spine Journal.2026;[Epub] CrossRef
Accuracy of the Cage Placement in Oblique Lumbar Interbody Fusion and its Effects on the Radiological Outcome in Lumbar Degenerative Disease Longwei Chen, Zhiyuan Han, Jianwei Wei, Yunlong Sun, Lantao Liu, Haifei Liu, Dechun Wang Global Spine Journal.2025; 15(1): 127. CrossRef
Therapy Potential of Oblique Lumbar Interbody Fusion 360 for Severe Lumbar Spinal Stenosis Lei Li, Yan Wang, Hao Zhang, Jialuo Han, Changpeng Qu, Yihao Sun, Hao Tao, Xuexiao Ma Orthopaedic Surgery.2025; 17(4): 1114. CrossRef
Osteogenic Potential and Bone Matrix Maturity: Comparison of Demineralized Bone Matrix and P15 Polypeptide iFactor® in an In Vitro Study Anell Olivos-Meza, Monica Maribel Mata-Miranda, Marcelo Robles-Rodríguez, Gustavo Jesús Vázquez-Zapién, Melissa Guerrero-Ruiz, Carlos Landa-Solís Medicina.2025; 61(5): 914. CrossRef
A Prospective Study of 3D Navigation-Guided Single-Position OLIF with Posterior Percutaneous Fixation Bharat Rajendraprasad Dave, Mrugank Narvekar, Ajay Krishnan, Devanand Degulmadi, Ravi Ranjan Rai, Mirant Bharat Dave Indian Spine Journal.2025; 8(2): 138. CrossRef
Single-position oblique lumbar interbody fusion with navigation: improved efficiency and screw accuracy compared to dual-position with fluoroscopy Hangeul Park, Hui Son, Jun-Hoe Kim, Sum Kim, Young-Rak Kim, Chang-Hyun Lee, Chun Kee Chung, Chi Heon Kim Scientific Reports.2024;[Epub] CrossRef
The Impact of Navigation in Lumbar Spine Surgery: A Study of Historical Aspects, Current Techniques and Future Directions Ahmed Majid Heydar, Masato Tanaka, Shrinivas P. Prabhu, Tadashi Komatsubara, Shinya Arataki, Shogo Yashiro, Akihiro Kanamaru, Kazumasa Nanba, Hongfei Xiang, Huynh Kim Hieu Journal of Clinical Medicine.2024; 13(16): 4663. CrossRef
Spinal Navigation for Lateral Instrumentation of the Thoracolumbar Spine Maximilian Schwendner, Raimunde Liang, Vicki M. Butenschöen, Sandro M. Krieg, Sebastian Ille, Bernhard Meyer Operative Neurosurgery.2023; 25(4): 303. CrossRef
Antepsoas Approaches to the Lumbar Spine Travis S. CreveCoeur, Colin P. Sperring, Anthony M. DiGiorgio, Dean Chou, Andrew K. Chan Neurosurgery Clinics of North America.2023; 34(4): 619. CrossRef
Incidence of major and minor vascular injuries during lateral access lumbar interbody fusion procedures: a retrospective comparative study and systematic literature review Alexander O. Aguirre, Mohamed A. R. Soliman, Shady Azmy, Asham Khan, Patrick K. Jowdy, Jeffrey P. Mullin, John Pollina Neurosurgical Review.2022; 45(2): 1275. CrossRef
Pearls and Pitfalls of Oblique Lateral Interbody Fusion: A Comprehensive Narrative Review Hyoungmin Kim, Bong-Soon Chang, Sam Yeol Chang Neurospine.2022; 19(1): 163. CrossRef
Techniques for psoas navigation in lateral lumbar interbody fusion Vyshak Chandra, Ken Porche, Gregory J.A. Murad, Adam J. Polifka Seminars in Spine Surgery.2022; 34(2): 100941. CrossRef
A Retrospective Comparative Analysis of Perioperative Complications in Navigated versus Conventional Thoracolumbar Fusion in the Setting of Adult Spinal Deformity Darius Ansari, Justin T. DesLaurier, Zayed Almadidy, Nauman S. Chaudhry, Ankit I. Mehta World Neurosurgery.2022; 162: e616. CrossRef
Radiation Dose Reduction and Surgical Efficiency Improvement in Endoscopic Transforaminal Lumbar Interbody Fusion Assisted by Intraoperative O-arm Navigation: A Retrospective Observational Study Junfeng Gong, Xinle Huang, Liwen Luo, Huan Liu, Hao Wu, Ying Tan, Changqing Li, Yu Tang, Yue Zhou Neurospine.2022; 19(2): 376. CrossRef
Characteristics and hotspots of the 50 most cited articles in the field of pre-psoas oblique lumbar interbody fusion Guang-Xun Lin, Chien-Min Chen, Shang-Wun Jhang, Ming-Tao Zhu, Pengfei Lyu, Bao-Shan Hu Frontiers in Surgery.2022;[Epub] CrossRef
Comparative Analysis of ABM/P-15, Bone Morphogenic Protein and Demineralized Bone Matrix after Instrumented Lumbar Interbody Fusion Ashwin Sathe, Sang-Ho Lee, Shin-Jae Kim, Sang Soo Eun, Yong Soo Choi, Shih-min Lee, Ju-Wan Seuk, Yoon Sun Lee, Sang-Ha Shin, Junseok Bae Journal of Korean Neurosurgical Society.2022; 65(6): 825. CrossRef
Single-Position Oblique Lumbar Interbody Fusion and Percutaneous Pedicle Screw Fixation under O-Arm Navigation: A Retrospective Comparative Study Hyung Cheol Kim, Yeong Ha Jeong, Sung Han Oh, Jong Min Lee, Chang Kyu Lee, Seong Yi, Yoon Ha, Keung Nyun Kim, Dong Ah Shin Journal of Clinical Medicine.2022; 12(1): 312. CrossRef
Novel Applications of Spinal Navigation in Deformity and Oncology Surgery—Beyond Screw Placement Elie Massaad, Ganesh M Shankar, John H Shin Operative Neurosurgery.2021; 21(Supplement): S23. CrossRef
Simultaneous Robotic Single-Position Surgery (SR-SPS) with Oblique Lumbar Interbody Fusion: A Case Series Luis Daniel Diaz-Aguilar, Vrajesh Shah, Alexander Himstead, Nolan J. Brown, Mickey E. Abraham, Martin H. Pham World Neurosurgery.2021; 151: e1036. CrossRef
Commentary: Oblique Lumbar Interbody Fusion From L2 to S1: 2-Dimensional Operative Video Yamaan S Saadeh, Michael J Strong, Whitney E Muhlestein, Timothy J Yee, Mark E Oppenlander Operative Neurosurgery.2021; 21(6): E573. CrossRef
The feasibility of computer-assisted 3D navigation in multiple-level lateral lumbar interbody fusion in combination with posterior instrumentation for adult spinal deformity Michael J. Strong, Timothy J. Yee, Siri Sahib S. Khalsa, Yamaan S. Saadeh, Kevin N. Swong, Osama N. Kashlan, Nicholas J. Szerlip, Paul Park, Mark E. Oppenlander Neurosurgical Focus.2020; 49(3): E4. CrossRef
Objective Lateral lumbar interbody fusion (LLIF) is a highly useful lumbar fusion surgical technique for degenerative spinal disease. However, many complications have already been reported. The purpose of this study is to report the concept, surgical technique, and clinical results of the first 70 consecutive cases treated with a safer and minimally invasive endoscopic-assisted LLIF (ELLIF).
Methods This retrospective study included 70 cases involving 106 segments in which ELLIF was used to treat degenerative spinal disease. We examined the clinical progress, complications and analyzed radiographic images. Regarding the fusion rate, 49 cases involving 72 segments whose follow-up period was more than 7 months were evaluated.
Results The mean of preoperative Numerical Rating Scale (NRS) was 7.0 and postoperative NRS was 1.4. Postoperative NRS had a significant correlation with the number of fusion segments (p = 0.028). The mean of preoperative disc space height, foraminal height, sagittal rotation angle, whole lumbar lordosis and sagittal translation distance were 3.3 mm, 14.3 mm, 2.4°, 9.7°, and 3.2 mm, respectively. Postoperative values were 9.4 mm, 17.9 mm, -4.9°, 36.3°, and 0.7 mm. The fusion rate was 79.2%. Complications included, transient psoas muscle weakness 1, sensory disturbance in the thigh 2, retroperitoneal injury 1, postoperative ileus possibly involving a retroperitoneal injury 1, and cage migration 4.
Conclusion Using the ELLIF in the degenerative spinal disease, we obtained good radiological reduction and good clinical results. Our study confirms that ELLIF is safer and provides better results for degenerative spinal disease. However, the issue of cage migration remains to be resolved.
An innovative minimally invasive technique for lumbar adjacent segment disease: a retrospective comparative analysis between extreme-oblique lumbar interbody fusion combined with percutaneous endoscopic lumbar discectomy(XOLIF-PELD) and posterior lumbar i Xiuqi Shan, Jilong An, Liang Li, Yapeng Sun, Jiaqi Li, Fei Zhang, Lei Guo, Wei Zhang Journal of Orthopaedic Surgery and Research.2025;[Epub] CrossRef
Is Minimally Invasive Spinal Surgery Superior to Endoscopic Spine Surgery in Postoperative Radiologic Outcomes of Lumbar Spine Degenerative Disease? A Systematic Review Kashyap Patel, Mandara Muralidhar Harikar, Tejas Venkataram, Vishal Chavda, Nicola Montemurro, Marjan Assefi, Namath Hussain, Vicky Yamamoto, Babak Kateb, Kai-Uwe Lewandrowski, Giuseppe E. Umana Journal of Neurological Surgery Part A: Central European Neurosurgery.2024; 85(02): 182. CrossRef
Overview of endoscopic spine surgery and learning curve Omri Maayan, Eric Mai, Ashley Yeo Eun Kim, Sravisht Iyer Seminars in Spine Surgery.2024; 36(1): 101079. CrossRef
Oblique Lumbar Interbody Fusion with Selective Biportal Endoscopic Posterior Decompression for Multilevel Lumbar Degenerative Diseases Woo-Myung Lee, Ki-Han You, Min-Seok Kang, Jun-Hyun Kim, Hyun-Jin Park Asian Spine Journal.2023; 17(2): 392. CrossRef
Endoscopic Techniques for Lumbar Interbody Fusion: Principles and Context Bryan Zheng, Elias Shaaya, Josh Feler, Owen P. Leary, Matthew J. Hagan, Ankush Bajaj, Jared S. Fridley, Frank Hassel, Raymond Gardocki, Ricardo Casal Grau, Kai-Uwe Lewandrowski, Albert E. Telfeian, Fu-Ming Tsai BioMed Research International.2022;[Epub] CrossRef
Instrumentation choice and early radiographic outcome following lateral lumbar interbody fusion (LLIF): Lateral instrumentation versus posterior pedicle screw fixation Sarah Nuss, Owen P. Leary, Bryan Zheng, Spencer C. Darveau, Adriel Barrios-Anderson, Tianyi Niu, Ziya L. Gokaslan, Prakash Sampath, Albert E. Telfeian, Adetokunbo A. Oyelese, Jared S. Fridley North American Spine Society Journal (NASSJ).2022; 12: 100176. CrossRef
Comparative Analysis of ABM/P-15, Bone Morphogenic Protein and Demineralized Bone Matrix after Instrumented Lumbar Interbody Fusion Ashwin Sathe, Sang-Ho Lee, Shin-Jae Kim, Sang Soo Eun, Yong Soo Choi, Shih-min Lee, Ju-Wan Seuk, Yoon Sun Lee, Sang-Ha Shin, Junseok Bae Journal of Korean Neurosurgical Society.2022; 65(6): 825. CrossRef
Endoscopic Lumbar Interbody Fusion G. Damian Brusko, Michael Y. Wang Neurosurgery Clinics of North America.2020; 31(1): 17. CrossRef
First
Prev
