What are the considerations and procedures for oblique lateral interbody fusion with posterior pedicle screw (PPS) placement?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: December 19, 2025 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

Oblique Lateral Interbody Fusion with Posterior Pedicle Screw Fixation

Surgical Technique and Approach

Oblique lateral interbody fusion (OLIF) with posterior pedicle screw (PPS) fixation represents a highly effective minimally invasive technique that can be performed either as a staged procedure or simultaneously in a single lateral position, with the simultaneous approach reducing operative time from 172 to 118 minutes and blood loss from 374 to 139 mL compared to traditional posterior approaches. 1

Single-Position Simultaneous Technique

  • The simultaneous lateral interbody and pedicle screws (SLIPS) technique allows for both OLIF and percutaneous pedicle screw placement in the lateral decubitus position without repositioning, consolidating what was traditionally a two-stage procedure into one stage. 2

  • Intraoperative CT-guided navigation eliminates the need for guiding fluoroscopy during simultaneous pedicle screw placement, reducing overall radiation exposure while maintaining accuracy. 2

  • Navigated robotic assistance achieves a 98% successful pedicle screw placement rate in the lateral position, with no malpositions requiring return to the operating room. 3

  • The anterior-to-psoas lateral approach capitalizes on a more oblique trajectory that facilitates simultaneous posterior screw placement without prone repositioning. 2

Clinical Outcomes and Fusion Rates

  • OLIF with PPS fixation achieves fusion rates of 96.8%, comparable to the 94.2% fusion rate with minimally invasive posterior/transforaminal lumbar interbody fusion (MI-PLIF/TLIF). 1

  • Cage height, change in disk height, and postoperative foraminal height are significantly superior with OLIF compared to posterior approaches, providing excellent indirect decompression. 1

  • Time to ambulation after surgery is reduced with the single-position OLIF technique compared to traditional posterior approaches. 1

Indications for Combined OLIF and PPS Fixation

  • Supplemental pedicle screw fixation is recommended as an adjunct to interbody fusion techniques to improve fusion rates and provide biomechanical stability, particularly in patients with spondylolisthesis or instability. 4

  • Interbody techniques with posterior instrumentation are associated with higher fusion rates (89-95%) compared to posterolateral fusion alone (67-92%) in patients with degenerative disc disease. 5

  • The addition of posterior instrumentation to interbody grafting improved fusion rates, with pseudarthrosis rates decreasing from 24% in stand-alone anterior approaches to 13% with combined fixation. 4

Complication Profile

  • The overall complication rate for OLIF is 32.34%, with a lower rate of 29.86% when combined with posterior pedicle screw fixation compared to 36.26% for OLIF alone. 6

  • Common complications include vascular injury (7 cases), endplate damage (22 cases), nerve injury (11 cases), cage subsidence or shifting (18 cases), and transient psoas weakness (9 cases) in a series of 235 patients. 6

  • The complication rate increases with the number of fusion segments: 30.0% for single-segment, 36.36% for two-segment, 42.86% for three-segment, and 46.15% for four-segment fusions. 6

  • When comparing OLIF with PPS to MI-PLIF/TLIF, the complication rate is lower with OLIF (6.3% versus 14.1%), though this difference was not statistically significant. 1

Technical Considerations and Pitfalls

  • OLIF combined with posterior pedicle screw fixation can be performed with the posterior instrumentation placed either primarily or in a delayed fashion, with 137 of 144 cases in one series receiving primary posterior fixation. 6

  • The lateral approach avoids posterior midline scarring, making it particularly advantageous for revision cases where previous posterior surgery has been performed. 7

  • Adequate endplate preparation is critical to minimize cage subsidence risk, while avoiding excessive endplate violation that could compromise structural integrity. 7

  • Visualization of the Kambin triangle and protection of exiting and traversing nerve roots with cottonoids is essential during the procedure. 7

Comparison to Alternative Approaches

  • Circumferential 360° fusion procedures (combining anterior/lateral interbody with posterior instrumentation) have higher early complication rates (31%) compared to posterolateral fusion alone (6%) or posterolateral fusion with screws (18%), though many complications are related to pedicle screw fixation rather than the interbody procedure itself. 4

  • Stand-alone OLIF without posterior fixation may be insufficient in cases with documented instability or spondylolisthesis, where supplemental fixation provides necessary biomechanical stability. 4

  • The addition of posterior instrumentation to interbody fusion may not require full posterior exposure for graft placement, as the interbody device provides the primary fusion substrate. 4

References

4
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

5
Guideline

Medical Necessity of Lumbar Fusion

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

Related Questions

Is L5-S1 anterior lumbar interbody fusion (ALIF), posterior spinal instrumentation fusion (PSIF), and possible transforaminal lumbar interbody fusion (TLIF) medically indicated for a patient with progressive bilateral radiating leg pain, severe low back pain, and multilevel spondylosis, who has failed conservative treatments and has a history of coronary artery disease, diabetes, gastroesophageal reflux disease (GERD), hypertension, hyperlipidemia, and tobacco use?
Is transforaminal lumbar interbody fusion (TLIF) at L4-5 medically indicated for a patient with severe pain, moderate bilateral neuroforaminal narrowing, and evidence of reherniation of the L4-5 disc, status post microdiscectomy?
Is medication or surgery medically indicated for a patient with spinal stenosis, spondylosis with radiculopathy, and spondylolisthesis, who has undergone procedures including arthrodesis, insertion of interbody biomechanical device (IBD), application of morselized allograft, pedicle screw fixation, and computer-assisted stereotactic navigation?
Is a minimally invasive posterior lumbar interbody fusion at L4-5, including CPT (Current Procedural Terminology) codes 22842, 22633, 22614, and 22853, medically necessary for a patient with spinal stenosis, lumbar region, and neurogenic claudication, who has tried physical therapy and various medications without success?
Is inpatient admission and the following procedures medically necessary for a patient with lumbar stenosis, foraminal stenosis, and radiculopathy: MIS Arthrodesis with TLIF (Transforaminal Lumbar Interbody Fusion) technique, laminectomy, facetectomy, foraminotomy, insertion of interbody biomechanical device, posterior spinal instrumentation, and use of autograft and allograft for bony fusion?
What is Fanapt (iloperidone) used for?
What is the treatment for a subdural hematoma?
Is new progressive facial asymmetry in a child more concerning if it is only present with smiling or at rest?
Is diathermy (electrocautery) capable of safely cutting an impacted meat bone in the esophagus after failed endoscopic removal attempts?
What is the most suitable long-term treatment option for nasal septal perforation in a patient with a history of epistaxis and reactions to blood products?
What is the recommended anesthesia management for a partial mastectomy?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question