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Multilevel Oblique Lumbar Interbody Fusion in Degenerative Lumbar Disc Disease with Instability
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Impact of Multiple Operative Levels on Radiographic Subsidence in Stand-Alone Lateral Lumbar Interbody Fusion
Nicole Don1, Samuel H Wakelin1, Zachary Spears1
1Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
World Neurosurgery
|May 1, 2026
Summary
Multilevel Lateral Lumbar Interbody Fusion (LLIF) may reduce implant subsidence. This minimally invasive technique shows promise for improving patient outcomes by decreasing postoperative concerns, independent of other surgical factors.
Area of Science:
- Spine surgery
- Minimally invasive spinal techniques
- Arthrodesis
Background:
- Lateral Lumbar Interbody Fusion (LLIF) is a minimally invasive technique for spinal arthrodesis.
- Implant subsidence remains a significant postoperative complication following LLIF procedures.
Purpose of the Study:
- To investigate the relationship between the number of operative levels and subsidence rates in LLIF.
- To identify factors influencing postoperative implant subsidence in LLIF patients.
Main Methods:
- Retrospective review of 144 patients undergoing LLIF between 2014-2022.
- Data collection included patient demographics, surgical variables (levels, cage material, plating), and bone density.
- Subsidence was graded by two independent spine surgeons using the Marchi criteria on postoperative imaging.
Main Results:
- Multivariable analysis indicated that increased operative levels were associated with decreased odds of subsidence (p=0.047).
- Age (p=0.013) and PEEK cage material (p=0.036) were associated with increased odds of subsidence.
- Lateral plating was associated with decreased odds of subsidence (p=0.03).
Conclusions:
- Multilevel stand-alone LLIF may independently reduce the rate of subsidence.
- Further biomechanical studies are warranted to elucidate the protective mechanisms of multilevel LLIF.
