title: Comparative Study of the Difference of Perioperative Complication and Radiologic Results: MIS-DLIF (Minimally Invasive Direct Lateral Lumbar Interbody Fusion) Versus MIS-OLIF (Minimally Invasive Oblique Lateral Lumbar Interbody Fusion).
abstract: Retrospective observatory analysis.
  
  
  
  The purpose of this study was to compare the incidence of perioperative complication, difference of cage location, and sagittal alignment between minimally invasive oblique lateral lumbar interbody fusion (MIS-OLIF) and MIS-direct lateral lumbar interbody fusion (DLIF) in the cases of single-level surgery at L4-L5.
  
  
  
  MIS-DLIF using tubular retractor has been used for the treatment of lumbar degenerative diseases; however, blunt transpsoas dissection poses a risk of injury to the lumbar plexus. As an alternative, MIS-OLIF uses a window between the prevertebral venous structures and psoas muscle.
  
  
  
  A total of 43 consecutive patients who underwent MIS-DLIF or MIS-OLIF for various L4/L5 level pathologies between November 2011 and April 2014 by a single surgeon were retrospectively reviewed. A complication classification based on the relation to surgical procedure and effect duration was used. Perioperative complications until 3-month postoperatively were reviewed for the patients. Radiologic results including the cage location and sagittal alignment were also assessed with plain radiography.
  
  
  
  There were no significant statistical differences in perioperative parameters and early clinical outcome between 2 groups. Overall, there were 13 (59.1%) approach-related complications in the DLIF group and 3 (14.3%) in the OLIF group. In the DLIF group, 3 (45.6%) were classified as persistent, however, there was no persistent complication in the OLIF group. In the OLIF group, cage is located mostly in the middle 1/3 of vertebral body, significantly increasing posterior disk space height and foraminal height compared with the DLIF group. Global and segmental lumbar lordosis was greater in the DLIF group due to anterior cage position without statistical significance.
  
  
  
  In our report of L4/L5 level diseases, the OLIF technique may decrease approach-related perioperative morbidities by eliminating the risk of unwanted muscle and nerve manipulations. Using orthogonal maneuver, cage could be safely placed more posteriorly, resulting in better disk and foraminal height restoration.
authors.affiliation: Graduate School, College of Medicine.
authors.forename: Jie
authors.initials: J
authors.lastname: Jin
authors.affiliation: Department of Neurosurgery, Seoul St Mary's Hospital, College of Medicine, the Catholic University of Korea, Seoul, Korea.
authors.forename: Kyeong-Sik
authors.initials: KS
authors.lastname: Ryu
authors.affiliation: Department of Neurosurgery, Seoul St Mary's Hospital, College of Medicine, the Catholic University of Korea, Seoul, Korea.
authors.forename: Jung-Woo
authors.initials: JW
authors.lastname: Hur
authors.affiliation: Department of Neurosurgery, Seoul St Mary's Hospital, College of Medicine, the Catholic University of Korea, Seoul, Korea.
authors.forename: Ji-Hoon
authors.initials: JH
authors.lastname: Seong
authors.affiliation: Department of Neurosurgery, Seoul St Mary's Hospital, College of Medicine, the Catholic University of Korea, Seoul, Korea.
authors.forename: Jin-Sung
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Seoul St Mary's Hospital, College of Medicine, the Catholic University of Korea, Seoul, Korea.
authors.forename: Hyun-Jin
authors.initials: HJ
authors.lastname: Cho
mesh_terms: D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000000981:diagnostic imaging / Q000601:surgery; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology*; D013123:Spinal Fusion / Q000009:adverse effects*; D055815:Young Adult