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Updated: Mar 1, 2026
Surgical Approach and Complications of Stand-alone Lateral Trans-Psoas Interbody Fusion
Published on: February 14, 2025
Safety of Lateral Interbody Fusion Surgery without Intraoperative Monitoring
Hong-Jae Lee1, Kyeong-Sik Ryu, Jung-Woo Hur
1Catholic University of Korea, College of Medicine, Daejeon St. Mary's Hospital, Department of Neurosurgery, Daejeon, Korea.
Aim:
Oblique lateral interbody fusion (OLIF) is a minimally invasive surgical method that can provide an access to the lumbar spine without direct dissection of psoas muscle and the need for intraoperative neuromonitoring (IOM) is questionable. The aim of this study was to examine and document the transient and persistent perioperative complications in patients who underwent OLIF for degenerative lumbar disease without IOM.
Material And Methods:
A total of 129 consecutive patients who were diagnosed as degenerative spinal disease from L1 to S1 and underwent mini-open OLIF were identified and retrospectively reviewed. All patients were classified as two groups; non-IOM group and IOM group. According to the relation to surgical procedure, the complications were divided into two groups; "procedurerelated" and "procedure-unrelated". Based on the effect of duration, the complications were defined as "transient" where the symptom is relieved within 30 days postoperatively, and "persistent" where the symptom remains for more than 30 days postoperatively.
Results:
The study groups comprised 57 cases in the IOM group and 72 in the non-IOM group. The complication rate was 24.6% (transient; 17.6%, persistent; 7.0%) in the IOM group and 29.2% (transient; 25.0%, persistent; 4.2%) in the non-IOM group. The incidence of postoperative leg symptoms related to lumbar plexus and/or psoas muscle injury was 6 transient and 3 persistent in the IOM group (overall 15.3%), and 12 transient and 3 persistent in the non-IOM group (overall 20.9%).
Conclusion:
Mini-open OLIF can be safely carried out without the aid of IOM.
Insights
Mini-open oblique lateral interbody fusion (OLIF) is safe without intraoperative neuromonitoring (IOM). This study found comparable complication rates between patients who did and did not receive IOM during OLIF surgery.
Area of Science:
- Spine surgery
- Minimally invasive procedures
- Neurosurgery
Background:
- Oblique lateral interbody fusion (OLIF) is a minimally invasive technique for lumbar spine access.
- The necessity of intraoperative neuromonitoring (IOM) during OLIF remains uncertain.
- Direct psoas muscle dissection is avoided in OLIF.
Purpose of the Study:
- To evaluate transient and persistent perioperative complications in patients undergoing OLIF without IOM.
- To compare complication rates between OLIF with and without IOM.
- To assess the safety of performing OLIF without IOM.
Main Methods:
- Retrospective review of 129 patients who underwent mini-open OLIF for degenerative lumbar disease.
- Patients were divided into two groups: non-IOM and IOM groups.
- Complications were categorized as procedure-related or unrelated, and transient (≤30 days) or persistent (>30 days).
Main Results:
- The non-IOM group (72 patients) had a 29.2% complication rate (25.0% transient, 4.2% persistent).
- The IOM group (57 patients) had a 24.6% complication rate (17.6% transient, 7.0% persistent).
- Leg symptoms related to lumbar plexus/psoas injury occurred in 20.9% of the non-IOM group and 15.3% of the IOM group.
Conclusions:
- Mini-open OLIF can be performed safely without intraoperative neuromonitoring.
- The study suggests IOM is not essential for safe OLIF procedures.
- Complication rates were similar between groups, supporting the safety of omitting IOM.
