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Updated: Mar 22, 2026
Surgical Approach and Complications of Stand-alone Lateral Trans-Psoas Interbody Fusion
Published on: February 14, 2025
Perioperative Complications in 155 Patients Who Underwent Oblique Lateral Interbody Fusion Surgery: Perspectives and
Koki Abe1, Sumihisa Orita1, Chikato Mannoji2
1Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
Study Design:
A retrospective multicenter survey.
Objective:
To investigate the perioperative complications of oblique lateral interbody fusion (OLIF) surgery.
Summary Of Background Data:
OLIF has been widely performed to achieve minimally invasive, rigid lumbar lateral interbody fusion. The associated perioperative complications are not yet well described.
Methods:
The participants were patients who underwent OLIF surgery under the diagnosis of degenerative lumbar diseases between April 2013 and May 2015 at 11 affiliated medical institutions. The collected data were classified into intraoperative and early-stage postoperative (≤1 mo) complications. The intraoperative complications were then subcategorized into organ damage (neural, vertebral, vascular, and others) and other complications, mainly related to instrumental failure. The collected data were also divided and analyzed based on whether the surgeon was certified to perform the surgery and the incidence of complications in the early (April 2013-March 2014) and late stages (April 2014-May 2015) of OLIF introduction.
Results:
In the 155 included patients, 75 complications were reported (incidence rate, 48.3%). The most common complication was endplate fracture/subsidence (18.7%), followed by transient psoas weakness and thigh numbness (13.5%) and segmental artery injury (2.6%). Almost all these complications were transient, except for three patients who had permanent damage: one had ureteral injury and two had neurological injury. Postoperative complications included surgical site infection (1.9%) and reoperation (1.9%). Whether the primary operator was experienced did not affect the incidence of complications. Regarding the introductory stage, the incidence of complications was 50% in the early stage and 38% in the late stage.
Conclusion:
The overall incidence of perioperative complications of OLIF surgery reached 48.3%, of which only 1.9% resulted in permanent damage. Our analysis based on surgeon experience indicated that the OLIF procedure could be performed without increasing incidence of complications, under the guidance of experienced supervisors.
Level Of Evidence:
3.
Insights
Oblique lateral interbody fusion (OLIF) surgery has a 48.3% complication rate, but only 1.9% result in permanent damage. Surgeon experience did not impact complication rates, suggesting supervised training is effective for safe OLIF procedures.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Orthopedic Surgery
Background:
- Oblique lateral interbody fusion (OLIF) is a minimally invasive technique for lumbar fusion.
- Perioperative complications associated with OLIF surgery require further detailed description.
Purpose of the Study:
- To investigate the incidence and types of perioperative complications following OLIF surgery.
- To analyze the impact of surgeon experience and learning curve on complication rates.
Main Methods:
- A retrospective multicenter survey of 155 patients undergoing OLIF for degenerative lumbar diseases.
- Complications were categorized as intraoperative or early postoperative, and analyzed based on surgeon experience and OLIF introduction stage.
Main Results:
- An overall complication rate of 48.3% was observed, with endplate fracture/subsidence (18.7%) being most common.
- Transient complications were frequent (e.g., psoas weakness, thigh numbness), with only 1.9% resulting in permanent neurological or ureteral injury.
- Complication rates decreased from 50% in the early introduction stage to 38% in the later stage.
Conclusions:
- OLIF surgery has a significant but predominantly transient complication rate.
- The procedure can be performed safely, even by less experienced surgeons, under supervision, as indicated by stable complication rates across experience levels and a learning curve effect.
