Comparative Analysis of Patient-reported Outcomes and Clinical Factors in Anterior and Oblique Lumbar Interbody Fusion

Introduction: Low back pain affects over 600 million people globally, a number expected to increase with the aging population. When conservative treatments fail, lumbar interbody fusion surgeries are often considered. This study investigates patient-reported outcomes, demographic, and surgical data to assess the effectiveness of anterior (ALIF) and oblique (OLIF) lumbar interbody fusion procedures.

Methods: This retrospective cohort study analyzed data from 190 patients at a large tertiary care center who underwent ALIF or OLIF for degenerative lumbar spinal conditions. Demographics, surgical data, and patient-reported outcomes measurement information system physical health (PROMIS-PH) scores were extracted from electronic medical records.

Results: Prior to propensity matching, there were 114 ALIF and 76 OLIF patients with significant differences in age, BMI, and operative time (p < 0.05). After 1:1 propensity-matching on age, BMI, operative time, estimated blood loss, number of levels decompressed and fused, smoking status, and prior lumbar spinal surgery, there were 70 patients in the ALIF and OLIF cohort with no differences in any demographic or surgical characteristic (p > 0.05). Readmission, emergency department visits, pseudoarthrosis, and instrument failure rates were similar between cohorts (p > 0.05). At 6 months postoperatively, the mean change in PROMIS-PH was 0.44 ± 18.79 and -5.05 ± 0.96 for ALIF and OLIF, respectively (p = 0.083). At 24 months postoperatively, the change in PROMIS-PH was 1.42 ± 22.37 and 0.96 ± 15.24, respectively (p = 0.897). The surgical approach was not associated with a significant change in any postoperative outcomes in a univariate model (p > 0.05).

Conclusion : After matching, there were no differences between ALIF and OLIF cohorts. There were no differences in outcomes between cohorts and surgical approach was not associated with a significant change in any outcome. Surgical approach ought not be considered a risk factor for complications in lumbar interbody fusion procedures.