Editorial
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Mar 18, 2025; 16(3): 100772
Published online Mar 18, 2025. doi: 10.5312/wjo.v16.i3.100772
Factors affecting outcomes of indirect decompression after oblique and lateral lumbar interbody fusions
Kyle M M Behrens, Hossein Elgafy
Kyle M M Behrens, Hossein Elgafy, Department of Orthopedics, University of Toledo Medical Centre, Toledo, OH 43614, United States
Author contributions: Elgafy H and Behrens KMM both made equally vital contributions regarding the manuscript writing, literature review and revisions of this editorial review. Both authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hossein Elgafy, FRCS (Ed), FRSC, MD, Professor, Surgeon, Department of Orthopedics, University of Toledo Medical Centre, 3065 Arlington Avenue, Toledo, OH 43614, United States. hossein.elgafy@utoledo.edu
Received: August 25, 2024
Revised: January 19, 2025
Accepted: February 12, 2025
Published online: March 18, 2025
Processing time: 198 Days and 8.5 Hours
Abstract

In this editorial, the authors of this paper comment on the article by Bokov et al published in the recent issue of World Journal of Orthopedics. We reviewed a general overview of oblique lumbar interbody fusions (OLIF) and lateral lumbar interbody fusions (LLIF), their indications and complications as an increasingly popular minimally invasive technique to address several lumbar pathologies. This editorial thoroughly discusses and reviews the literature regarding factors affecting outcomes of indirect decompression utilized through OLIF and LLIF procedures. Several parameters play a critical role in patient outcomes including restoration of disc height, foraminal height, central canal squared, and foraminal area. The indirect decompression allows for unbuckling of the ligamentum flavum which can significantly decompress the neural elements as well as aid in reduction of spondylolisthesis. However, the authors further highlight the limitations of indirect decompression and factors that may predict unsuccessful outcomes including bony foraminal stenosis, severe central canal stenosis, and osteoporosis. As a result, failure of indirect decompression can lead to persistent pain, radiculopathy and unsatisfied patients. Spinal surgeons may be left to reimage patients and consider additional procedures with direct decompression.

Keywords: Interbody fusion; Indirect decompression; Spinal stenosis; Foraminal stenosis; Lumbar

Core Tip: Oblique and lateral lumbar interbody fusions indirectly decompress the spinal canal and foramina providing surgeons minimally invasive techniques for a multitude of spinal pathologies. It allows for restoration of foraminal height, disc height, central canal squared via unbuckling the ligamentum flavum. However, limitations to indirect decompression such as bony foraminal stenosis, severe central canal stenosis and osteoporosis put patients at risk of poor outcomes due to inadequate decompression and potentially requiring additional direct decompressive procedures.