Two-Year Outcomes From a Single Surgeon's Learning Curve Experience of Minimally Invasive Oblique Lateral Interbody Fusion in Degenerative Lumbar Spine Disorders

Objective: Minimally invasive oblique lateral interbody fusion (MIS OLIF) is a proven technique to achieve indirect decompression and fusion in degenerative lumbar spine disorders. However, it poses the risk of approach-related complications. Furthermore, ideal patient selection for optimal clinical and radiological outcomes can be difficult during the learning curve. In this study, we assessed the learning curve, clinical outcomes, and complication rate in 22 patients who underwent surgery performed by a single surgeon at a single center during a 2-year period.Methods: This was a retrospective study. MIS OLIF was performed in 24 segments of 22 patients over the period of 26 months. Patients with degenerative lumbar spine disorders were included. Indirect decompression by distraction was achieved in all patients. No neuromonitoring was conducted. All known complications were analyzed prospectively. Perioperative complications were noted. Changes in estimated blood loss, operative time, and complications were analyzed. All patients were clinically and radiologically evaluated.Results: Nine patients were male and 13 were female. The operative time decreased (mean time: 50 minutes for single-level cage insertion). Estimated blood loss was 40–70 mL. In the initial part of the learning curve, patients with Schizas grade C on magnetic resonance imaging and listhesis more than grade 1 were avoided. Transient psoas weakness was the commonest (n=4) perioperative complication. One patient had venous bleeding. By the modified MacNab criteria, 20 of 22 patients (91%) had excellent outcomes, while 2 (9%) had good outcomes.Conclusion: The operative time and psoas paresis decreased throughout the learning curve. It is important to select ideal cases from clinical and radiological points of view to achieve satisfactory indirect decompression and to minimize vascular and neurological complications. MIS OLIF can be the procedure of choice for degenerative lumbar spine disorders, even during the initial learning curve.