• Worawat Limthongkul, Rawijak Chantharakomen, Teerachat Tanasansomboon, Wicharn Yingsakmongkol, Yoong-Leong OhJacobJDepartment of Orthopedic surgery, Tan Tock Seng Hospital, Singapore., Vit Kotheeranurak, and Weerasak Singhatanadgige.
• Department of Orthopedics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand.
• World Neurosurg. 2022 Apr 1; 160: e322-e327.

ObjectiveTo compare location and amount of unremoved intervertebral disc between extreme lateral lumbar interbody fusion (XLIF) and oblique lateral lumbar interbody fusion (OLIF).MethodsPostoperative magnetic resonance images of patients who underwent XLIF and OLIF for degenerative spine diseases were reviewed. An axial cut T2-weighted image that was the middle cut of operated disc space was selected. We divided the disc area into 5 zones: central, left anterior, left posterior, right anterior, and right posterior. Disc area was measured using a picture archiving and communication system program. The angle of intervertebral cage was also measured.ResultsA total of 61 levels of XLIF from 51 patients and 62 levels of OLIF from 34 patients were included. The area of unremoved disc at left anterior, right anterior, and left posterior zones of OLIF were significantly greater than XLIF (55.7 ± 41.5 vs. 29.8 ± 33.3 mm2, 57.9 ± 43.6 vs. 34.1 ± 33.1 mm2, and 50.5 ± 41.8 vs. 31.5 ± 35.9 mm2, respectively; P < 0.01). No significant differences were found at the right posterior and central zones. A 9.2° ± 6.1° and 0.7° ± 4.9° cage angulation from left anterior to right posterior was found in OLIF and XLIF, respectively, with statistical significance.ConclusionsOur study found a greater area of unremoved disc in OLIF compared with XLIF. The common locations were in the contralateral side of the surgical approach-right anterior in OLIF, and right posterior in XLIF. The greater area of the unremoved disc in the anterior zone after OLIF due to oblique corridor to disc space may cause cage malposition. Meticulous disc removal should be performed, especially in OLIF, to prevent complications.Copyright © 2022 Elsevier Inc. All rights reserved.

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