• Sven Bamps, Vincent Raymaekers, Gert Roosen, Eric Put, Steven Vanvolsem, Salah-Eddine Achahbar, Sacha Meeuws, Maarten Wissels, and Mark Plazier.
• Department of Neurosurgery, Jessa Hospital, Hasselt, Belgium; Department of Neurosurgery, St. Trudo Hospital, Sint-Truiden, Belgium; Department of Neurosurgery, St. Franciscus Hospital, Heusden-Zolder, Belgium; Study and Training Center Neurosurgery, Virga Jesse, Hasselt, Belgium; Faculty of Medicine and Life Science, Hasselt University, Hasselt, Belgium. Electronic address: Sven.bamps@jessazh.be.
• World Neurosurg. 2023 Mar 1; 171: 101810-18.

BackgroundDegenerative diseases of the lumbar spine are often treated with posterior interbody fusion surgery (posterior lumbar interbody fusion [PLIF]) for spinal instability or intractable back pain with neurologic impairment. Several lateral, less invasive procedures have recently been described (lateral lumbar interbody fusion [LLIF]/direct lateral interbody fusion/extreme lateral interbody fusion [XLIF]). The aim of this systematic review is to compare structural and functional outcomes of lateral surgical approaches to PLIF.MethodsWe conducted a MEDLINE (PubMed), Web of Science, ScienceDirect, and Cochrane Library search for studies focusing on outcomes and complications comparing LLIF (direct lateral interbody fusion/XLIF) and PLIF. The systematic review was reported using the PRISMA criteria.ResultsIn total, 1000 research articles were identified, of which 5 studies were included comparing the outcomes and complications between the lateral and posterior approach. Three studies found significantly less perioperative blood loss with a lateral approach. Average hospital stay was shorter in populations who underwent the lateral approach compared with PLIF. Functional outcomes (visual analog scale score/Oswestry Disability Index) were similar or better with LLIF. In most of the included studies, complication rates did not differ between the posterior and lateral approach. Most of the neurologic deficits with XLIF/LLIF were temporary and healed completely within 1 year follow-up.ConclusionsA lateral approach (XLIF/LLIF) is a good and safe alternative for PLIF 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.Copyright © 2022 Elsevier Inc. All rights reserved.

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