Infection Rates Following Trans-Kambin Oblique Lateral-Posterior Lumbar Interbody Fusion and Associated Procedures: A Review of 2,069 Cases

Low back pain remains one of the leading causes of disability worldwide and continues to impose a substantial burden on healthcare systems. Lumbar fusion procedures have increased significantly over recent decades due to an aging population, expanded surgical indications, and advances in minimally invasive surgical (MIS) techniques. Compared with traditional open approaches, MIS lumbar fusion techniques have demonstrated reduced tissue disruption, improved recovery, and lower complication rates. Among postoperative complications, surgical site infection (SSI) remains one of the most clinically significant because of its association with increased morbidity, prolonged hospitalization, reoperation, and increased healthcare costs. Although infection rates following traditional lumbar fusion procedures are well documented, large-scale studies specifically evaluating infection rates following minimally invasive trans-Kambin oblique lateral lumbar interbody fusion (OLLIF) remain limited. Early studies have suggested that MIS approaches may reduce the risk of postoperative infection by decreasing soft-tissue disruption and intraoperative exposure. In addition, patient-related factors such as diabetes mellitus, smoking, and elevated body mass index (BMI) are recognized contributors to postoperative infectious complications. In this series of more than 2,069 consecutive minimally invasive lateral and oblique interbody fusion procedures performed over a 14-year period, the overall postoperative infection rate was low at 0.39%, with deep infections occurring in 0.11% of cases. When analyzed by technique, pure minimally invasive OLLIF procedures demonstrated an exceptionally low infection rate of 0.24%, whereas cases requiring an additional open posterior component had a significantly higher infection rate of 1.83% (OR = 7.66; p = 0.009). These findings suggest that infection risk was primarily associated with open exposure rather than the OLLIF technique itself. Additional factors associated with increased infection risk included revision surgery, multilevel constructs, obesity (BMI > 30 kg/m²), and elevated HbA1c levels. The two deep infections appeared to result from different mechanisms, including likely hematogenous spread and a true postoperative SSI. Overall, these findings support a favorable infection profile for the minimally invasive trans-Kambin OLLIF approach, with a markedly increased risk when open posterior components are introduced.