Factors affecting disc angle restoration in oblique lateral interbody fusion at L5–S1

Abstract

BACKGROUND CONTEXT: Optimal restoration of the L5–S1 disc angle (DA) is an important surgical goal in spinal reconstructive surgery. Anterior approach is beneficial for L5–S1 DA reconstruction and fusion. However, factors associated with a greater DA restoration in oblique lateral interbody fusion (OLIF) at L5–S1 have not been studied. PURPOSE: This study aimed to identify factors that aid in achieving a greater DA in OLIF at L5–S1. STUDY DESIGN/SETTING: A retrospective analysis. PATIENT SAMPLE: This study involved 61 consecutive patients who underwent OLIF at L5–S1 for lumbar degenerative disease and were followed for more than 1 year. Patients with incomplete data or posterior column osteotomy at L5–S1 were excluded. OUTCOME MEASURES: The L5–S1 DA was measured preoperatively, postoperatively, and at the last follow-up on standing lateral lumbar radiographs. The associations between demographics and/or surgical and/or radiological factors and the L5–S1 DA at the last follow-up were analyzed using multiple regression analysis. METHODS: Demographics and surgical factors were reviewed from the medical records with respect to age, sex, body mass index, bone mineral density, diagnosis, surgery level, cage parameters (cage lordotic angle and height), laminectomy performed and/or not performed, estimated blood loss, operative time, configuration of the left common iliac vein. Radiological factors were measured with respect to sagittal parameters, the L5–S1 disc parameters, and the postoperative cage parameters. RESULTS: The mean preoperative DA at L5–S1 was 5.4±5.0°, which increased to 18.9±5.6° postoperatively (p<.001) and was maintained as 16.5±5.9° at the last follow-up (p<.001). The preoperative DA, end plate lesions, anterior spur, facet joint osteoarthritis, or cage position at L5–S1 did not affect the DA at the last follow-up (all p>.05). Multiple regression analysis showed four independent variables, including increased age, increased cage lordotic angle, laminectomy performed, and absence of cage subsidence as the factors associated with the greater DA at L5–S1. CONCLUSIONS: OLIF at L5–S1 showed favorable DA restoration regardless of the preoperative conditions. To achieve a greater DA, surgeons should try to distract the anterior disc space for insertion of a larger lordotic cage. Laminectomy during posterior fixation is recommended for achieving additional DA restoration.