Supine ALIF versus Lateral-Decubitus OLIF for Degenerative Lumbar Disease: A Systematic Review and Meta-Analysis of Comparative Studies.

IF 3.7 2区医学 Q2 CLINICAL NEUROLOGY

Spine Pub Date : 2026-10-15 DOI:10.1097/BRS.0000000000005905

Ishan D Shah, Puru Sadh, Vikram Sharma, Tasif Mahmoud, Alan H Daniels, Bryce A Basques

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引用次数: 0

Abstract

Study design: Systematic review and meta-analysis.

Objective: To compare outcomes between supine anterior lumbar interbody fusion (ALIF) and lateral decubitus oblique lumbar interbody fusion (OLIF).

Background: ALIF and OLIF differ in surgical corridor and patient positioning, with their relative advantages remaining debated.

Methods: A PRISMA-compliant search of PubMed, Embase, and Google Scholar was performed through April 2026 for studies evaluating anterior versus oblique lumbar interbody fusion. Outcomes included perioperative, complication, patient-reported, and sagittal alignment measures, pooled using fixed- or random-effects models based on heterogeneity (I²>50%).

Results: Thirteen studies (1,432 patients; 795 ALIF, 637 OLIF) met inclusion criteria. OLIF was associated with shorter length of stay (-0.87 days [95% CI: -1.47 to -0.26], P=0.005). Leave-one-out analyses demonstrated lower operative time (-39.07 minutes [95% CI: -76.73 to -1.41], P=0.04) and estimated blood loss (-96.32 mL [95% CI: -182.03 to -10.61], P=0.03) favoring OLIF, though substantial heterogeneity persisted. Complications and patient-reported outcomes did not differ. OLIF showed greater reductions in sagittal vertical axis (SVA) immediately postoperatively (-18.32 mm [95% CI: -30.89 to -5.75], P=0.004) and at final follow-up (-9.39 mm [95% CI: -17.83 to -0.96], P=0.03). In a subanalysis of fusions involving the sacrum, OLIF had lower EBL (-182.32 mL [95% CI: -297.38 to -67.27], P=0.002) and shorter LOS (-1.45 days [95% CI: -1.72 to -1.18], P<0.00001), with a similar operative time trend (-72.83 min [95% CI: -147.48 to 1.81], P=0.06).

Conclusions: OLIF appears to offer a modest advantage over ALIF, with shorter hospitalization, comparable complications and patient-reported outcomes, and greater SVA correction. These perioperative benefits could potentially be meaningful in patients with higher comorbidity burden and appeared preserved in fusions involving the sacrum. The SVA correction may reflect advantages of single-position lateral surgery for restoring global alignment.

Level of evidence: III.

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来源期刊

Spine 医学-临床神经学

CiteScore

5.90

自引率

6.70%

发文量

361

审稿时长

6.0 months

期刊介绍： Lippincott Williams & Wilkins is a leading international publisher of professional health information for physicians, nurses, specialized clinicians and students. For a complete listing of titles currently published by Lippincott Williams & Wilkins and detailed information about print, online, and other offerings, please visit the LWW Online Store. Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of Spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. The Journal does not publish articles reporting material that has been reported at length elsewhere.