Ibero-Latin American Consensus on Oblique Lumbar Interbody Fusion (L2-L5): A Modified Delphi Study

Area of Science:

• Spine surgery
• Minimally invasive spine surgery
• Neurosurgery

Background:

• Oblique lumbar interbody fusion (OLIF) is a minimally invasive technique for lumbar spine pathologies.
• Standardized protocols for OLIF 25 are lacking, particularly in the Ibero-Latin American region.
• Expert consensus is crucial for refining surgical techniques and improving patient outcomes.

Purpose of the Study:

• To establish expert consensus on the surgical application of oblique lumbar interbody fusion at the L2/5 spinal level (OLIF 25).
• To develop standardized guidelines for OLIF 25 procedures using a modified Delphi process.
• To provide a framework for consistent OLIF 25 practice in Ibero-Latin America.

Main Methods:

• A modified Delphi process involving 17 experienced spine surgeons from Iberia and Latin America.
• Four rounds of consensus-building, including one face-to-face meeting and three online surveys.
• Consensus defined as ≥70% agreement, with grading of strong (≥90%), moderate (80%-89.9%), and weak (70%-79.9%).

Main Results:

• Consensus was achieved on 45 out of 56 statements (80.4%) across four domains: preoperative assessment, technology/instrumentation, intraoperative considerations, and postoperative care.
• Key agreements included mandatory MRI for corridor assessment, indirect foraminal decompression, and favorable indications for grade I degenerative spondylolisthesis.
• Major contraindications identified were severe canal stenosis with blocked facets and prior ipsilateral retroperitoneal surgery; high-risk steps included pin fixation and retractor opening.

Conclusions:

• This study presents the first Delphi-based regional consensus on OLIF 25.
• The consensus provides structured expert guidance on imaging, indications, contraindications, and intraoperative safety.
• This framework aims to standardize OLIF 25 surgical practice within the Ibero-Latin American region.