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Updated: Mar 29, 2026
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Multilevel Oblique Lumbar Interbody Fusion in Degenerative Lumbar Disc Disease with Instability
Published on: July 25, 2025
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The Limited Evidence Base for Multilevel Lumbar Interbody Fusion and Its Consequences for Clinical Conclusions: A
Evan R Simpson1, Casey Slattery1, Kalyn Smith1
1Hoag Orthopedics, Irvine, CA 92618, USA.
Journal of Clinical Medicine
|March 28, 2026
Summary
This systematic review compared multilevel lumbar interbody fusion (LIF) techniques. While transforaminal LIF (TLIF) showed shorter operative times, lateral approaches offered better radiographic outcomes for degenerative lumbar spine conditions.
Area of Science:
- Spine Surgery
- Orthopedics
- Neurosurgery
Background:
- Multilevel degenerative lumbar spine pathologies are commonly treated with lumbar interbody fusion (LIF).
- A comprehensive review of lateral and posterior multilevel LIF procedures is needed to clarify clinical and radiographic outcomes.
Purpose of the Study:
- To systematically review and compare clinical and radiographic outcomes of lateral and posterior multilevel lumbar interbody fusion (LIF) procedures.
- To identify the most effective LIF techniques for treating degenerative lumbar spine conditions.
Main Methods:
- A systematic literature search was conducted across PubMed, Embase, Web of Science, and Cochrane databases following PRISMA guidelines.
- Data on patient demographics, clinical outcomes (e.g., ODI, VAS pain scores), and radiographic outcomes were collected from 45 included studies (5623 patients).
- Risk of bias was assessed using MINORS criteria and RoB-2 tool for randomized trials, with subgroup analyses performed where possible.
Main Results:
- Transforaminal LIF (TLIF) demonstrated the shortest operative duration and length of stay, with favorable improvements in Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) pain scores.
- Lateral lumbar interbody fusion (LLIF) and oblique lumbar interbody fusion (OLIF) showed superior radiographic improvements compared to posterior approaches.
- Comparative evidence questioned autogenous bone use in posterior lumbar interbody fusion (PLIF), favored PEEK over HA/PA66 cages, and found no benefit in unilateral decompression for TLIF.
Conclusions:
- This review highlights that while pooled data favored TLIF, publication bias was detected, and comparative evidence suggests advantages for lateral and oblique LIF approaches.
- Current evidence lacks conclusive superiority for any single multilevel LIF technique.
- Further high-quality studies are required to guide optimal clinical decision-making for multilevel lumbar pathology treatment.
