Lumbar interbody fusion via anterior lumbar interbody fusion versus oblique lumbar interbody fusion versus lateral lumbar interbody fusion - a narrative review for surgeons

Sep 30, 2026

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Anterior column lumbar interbody fusion is performed using ALIF, OLIF/ATP, or LLIF through retroperitoneal corridors, enabling placement of a wide-footprint interbody cage. These approaches aim to achieve immediate segmental stability, indirect neural decompression, restoration of coronal and sagittal balance, and access for disc preparation with high fusion rates and generally lower blood loss than posterior fusion in most settings. A narrative review compares indications, surgical technique, learning curve, complications, radiation exposure, and outcomes to support contemporary decision-making for spine surgeons.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages12

Reading Time30 min

AccessFree to download

Background and Objective

Methods

Key Content and Findings

Conclusions

Introduction

Lumbar interbody fusion via anterior lumbar interbody fusion versus oblique lumbar interbody fusion versus lateral lumbar interbody fusion: a narrative review for surgeons Gregory M. Malham1,2,3,4,5, Kevin A. Seex6, Matthew H. Claydon1,2 1Department of Neurosciences, Epworth Richmond, Melbourne, VIC, Australia; 2Spine Surgery Research Foundation, Richmond, VIC, Australia; 3Spine Surgery Research, Swinburne University of Technology, Melbourne, VIC, Australia; 4Department of Surgery, Facility of Medicine, Dentistry and Health Science, University of Melbourne, Parkville, VIC, Australia; 5School of Health and Biomedical Sciences, RMIT, Melbourne, VIC, Australia; 6Neurosurgery Department, Macquarie University, Sydney, NSW, Australia Contributions: (I) Conception and design: GM Malham; (II) Administrative support: GM Malham; (III) Provision of study materials or patients: All authors; (IV) Collection and assembly of data: All authors; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Gregory M. Malham, FRACS. Department of Neurosciences, Epworth Richmond, Melbourne, VIC, Australia; Spine Surgery Research Foundation, Richmond, VIC, Australia; Spine Surgery Research, Swinburne University of Technology, Pacific Tower, Suite 5.04, 737 Burwood Road, Hawthorn East, Melbourne, VIC 3123, Australia; Department of Surgery, Facility of Medicine, Dentistry and Health Science, University of Melbourne, Parkville, VIC, Australia; School of Health and Biomedical Sciences, RMIT, Melbourne, VIC, Australia. Email: [greg@gregmalham.com.au](greg@gregmalham.com.au). 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. Keywords: Anterior lumbar interbody fusion (ALIF); anterior-to-psoas fusion (ATP); lateral lumbar interbody fusion (LLIF); oblique lumbar interbody fusion (OLIF); lumbar spine Submitted Jan 25, 2025. Accepted for publication Aug 26, 2025. Published online Sep 19, 2025. doi: 10.21037/jss-25-14 View this articl

FAQs

What is the main purpose of the review comparing ALIF, OLIF/ATP, and LLIF?

To compare ALIF, OLIF/ATP, and LLIF techniques and provide a contemporary pragmatic guide for spine surgeons across clinical and perioperative considerations.

Which databases and study timeframe were used in the methods?

PubMed and Ovid Medline were searched for English-language studies published from 2000 to 2024.

What outcomes and factors were emphasized when comparing the surgical techniques?

The review compared patient factors, anesthetic factors, surgical factors, operative efficiency, surgical risks, and economic factors, including indications, approaches, positioning, complications, radiation exposure, and supplemental fixation needs.

Sep 30, 2026

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