Abstract
BACKGROUND AND OBJECTIVE: Anterior column lumbar interbody fusion using an anterior lumbar interbody fusion (ALIF), oblique lumbar interbody fusion (OLIF)/anterior-to-psoas fusion (ATP), lateral lumbar interbody fusion (LLIF), or combination technique allows insertion of a wide-footprint interbody cage and provides immediate segmental stability, indirect neural decompression, lower risk of subsidence, access for disc preparation, the ability to use a large volume of graft, and restoration of coronal and sagittal balance. Blood loss is usually less than with posterior fusion procedures, except for rare cases of severe vascular injury. The objective of this review was to compare the ALIF, OLIF/ATP, and LLIF techniques to provide a contemporary pragmatic guide for spine surgeons. METHODS: PubMed and Ovid Medline databases were searched to identify English-language studies published from 2000 to 2024. The search terms were "anterior", "fusion", "interbody", "lateral", "lumbar", and "oblique". We included studies describing the indications, approaches, patient positioning, surgical technique, learning curve, complications, radiation exposure, need for supplemental fixation, and clinical and radiologic outcomes of ALIF, OLIF/ATP, and LLIF procedures. KEY CONTENT AND FINDINGS: This review compared the ALIF, OLIF/ATP, and LLIF techniques regarding patient factors, anesthetic factors, surgical factors, operative efficiency, surgical risks, and economic factors. We focused on differences between techniques to help clinicians choose between procedures and identified the preferred procedure(s) at each spinal level. We supplemented data from the literature with practical information obtained from our substantial clinical experience with these procedures. CONCLUSIONS: ALIF, OLIF/ATP, and LLIF are all effective techniques for anterior interbody fusion, which provide very good long-term clinical outcomes, excellent fusion rates, and low but specific complication rates.