Introduction:

Degenerative diseases of the lumbar spine are often treated with posterior interbody fusion surgery (PLIF) for spinal instability or intractable back pain with neurological impairment. Several lateral, less invasive procedures have been recently described (LLIF/DLIF/XLIF). The aim of this systematic review is to compare structural and functional outcomes of lateral surgical approaches to PLIF.

Methods:

We conducted a Medline (Pubmed), Web of Science, Science direct and Cochrane Library search for studies focusing on outcomes and complications comparing lateral lumbar interbody fusion (LLIF/DLIF/XLIF) and posterior lumbar interbody fusion (PLIF). The systematic review was reported using the PRISMA criteria.

Results and discussion:

In total 1000 research articles were identified of which five studies were included comparing the outcomes and complications between the lateral and posterior approach. Three studies found significant less perioperative blood loss with a lateral approach. Average hospital stay was shorter in populations which underwent the lateral approach compared to PLIF. Functional outcomes (VAS/ODI) were similar or better with lateral lumbar interbody fusion. In the majority of the included studies, complication rates did not differ between the posterior and lateral approach. Most of the neurological deficits with XLIF/LLIF were temporary and healed completely within one-year follow up.

Conclusion:

A lateral approach (XLIF/LLIF) is a good and safe alternative for posterior lumbar interbody fusion in single level degenerative lumbar diseases with comparable functional outcomes, shorter hospital stays and less blood loss. Future prospective studies are needed to establish the role of lateral, minimally invasive approaches in spinal degenerative surgery.