Optimizing lie-to-stand time to avoid orthostatic intolerance during early mobilization after enhanced recovery after surgery program for minimally invasive spine surgery: oblique lateral interbody fusion versus minimally invasive transforaminal lumbar interbody fusion: a prospective cohort study in Thailand.

Study design: Prospective study.

Purpose: To evaluate the hemodynamic response to early mobilization following oblique lateral interbody fusion (OLIF) compared to minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) with an enhanced recovery after surgery (ERAS) program.

Overview of literature: The ERAS program mitigates surgical stress and facilitates early recovery. Orthostatic intolerance (OI) may impede early mobilization after spine surgery. Data on OI after OLIF and MIS-TLIF with an ERAS are limited. This study compares OI incidence and outcomes of these two procedures.

Methods: The hemodynamic response to postural changes (supine to sitting and standing) was evaluated preoperatively and at 6, 12, 24, and 48 hours postoperatively in 30 patients who underwent single-level OLIF versus MIS-TLIF within an ERAS protocol. The protocols were evaluated sequentially, beginning with a change from supine to sitting, followed immediately by standing, with the patient remaining in the standing position for 3 minutes for evaluation.

Results: This study compared OLIF and MIS-TLIF in 60 patients and found no significant differences in baseline characteristics. The OLIF group demonstrated greater hemodynamic stability within 6 hours after surgery, exhibiting smaller decreases in systolic blood pressure and mean arterial pressure, along with reduced fluid responsiveness compared to the MIS-TLIF group. Both groups of patients exhibited comparable heart rates and cardiac output stabilization over time. Clinically, OLIF resulted in greater postoperative back pain relief, lower blood loss (45±7.31 mL vs. 99.33±14.13 mL), and higher postoperative hemoglobin levels compared to MIS-TILF. Operative time, hospital stay, and complication rates were comparable between the OLIF and MIS-TLIF groups.

Conclusions: OLIF was associated with improved hemodynamic parameters within 6 hours postoperatively, less blood loss, and improved pain relief compared to MIS-TLIF, while both procedures demonstrated similar operative times, hospital stays, and no complications.