ABSTRACT
STUDY
DESIGN:
Retrospective, single-center study.
PURPOSE:
We aimed to determine the perioperative
complications of oblique lumbar interbody fusion (OLIF) as a first-stage
procedure in combined anterior and posterior operation for
adult spinal
deformity (ASD) along with sagittal imbalance. Specifically, we aimed to identify the radiological and clinical types of perioperative surgical
complications and the factors affecting these
complications. OVERVIEW OF
LITERATURE OLIF has recently gained popularity, and there are several
reports of good outcomes and only a few of
complications with OLIF; however, a few studies have focused on the perioperative surgical
complications of ASD along with sagittal imbalance.
METHODS:
The
perioperative period was a 1-week interval between the anterior and posterior
procedures. All
patients underwent simple
radiography and
magnetic resonance imaging preoperatively and postoperatively. Cage placement was evaluated for displacement (i.e.,
subsidence and migration) and
vertebral body fracture. Clinical
patient complaints were evaluated perioperatively.
Student t-test was used for
data analysis.
RESULTS:
A total of 46
patients were included, totaling 138 fusion segments. A week after OLIF, 14
patients/33 segments (30.4%/23.9%) demonstrated endplate
injury-associated cage placement change.
Subsidence was the most common cage placement-related complication. As compared with
patients without endplate
injury, those with endplate
injuries showed significantly larger correction angles and a higher proportion of them had larger height cages than the disk height in the full-extension lateral view. Although 32.6% of the
patients experienced perioperative clinical
complications, they were relatively
minor and
transient. The most common complication was severe
postoperative pain (
Visual Analog Scale score of >7), and
hip flexor weakness spontaneously resolved within 1 week.
CONCLUSIONS:
OLIF yielded more than expected endplate
injuries from
treatment modalities for ASD along with sagittal imbalance. Therefore,
surgeons should be cautious about endplate
injury during OLIF
procedures. It is difficult to accomplish
lordosis correction via OLIF alone; therefore,
surgeons should not attempt this impractical correction
goal and insert an immoderate cage.