Comparative effectiveness of lumbar interbody fusion techniques in adult scoliosis: a systematic review and meta-analysis of postoperative alignment and disability outcomes.

Background: Adult scoliosis, marked by degenerative and pathological changes in the spinal column, is a growing health concern, particularly among the elderly, often leading to chronic pain and functional limitations. Initial management typically includes conservative approaches such as physical therapy; however, persistent symptoms frequently necessitate surgical intervention. Recently, lumbar interbody fusion (LIF) techniques, including lateral lumbar interbody fusion (LLIF) and oblique lumbar interbody fusion (OLIF) approaches, have gained attention as less invasive alternatives to traditional open spinal surgery. This study aims to provide a systematic review of the efficacy and safety of lateral interbody fusion of the lumbar spine in the available literature to inform clinical decision-making. We hypothesize that lateral interbody fusion provides a viable surgical option with favorable reductions in postoperative Cobb angle. Methods: A systematic review was conducted to examine the outcomes of LIF in adult scoliosis patients. PubMed/MEDLINE, Embase, and Scopus were queried in January 2024 to identify relevant articles published since 2010. Articles were screened for inclusion based on predefined criteria, and data extraction was performed to collect demographic, clinical, functional, and radiographic measurements. Statistical analysis was conducted using a random effects model to assess primary outcomes of interest, including changes in Oswestry Disability Index (ODI) scores and Cobb angle measurements before and after LIF surgical intervention. The robvis tool was employed to create standardized visualizations of risk of bias across included studies. Results: The systematic review identified 46 articles that met the inclusion criteria, of which eight studies, encompassing a total of 424 patients, were selected for final analysis. Five of these eight studies, involving 289 patients, specifically examined outcomes for those who underwent LIF. Meta-analysis of available data revealed a statistically significant reduction in postoperative Cobb angle following LIF (mean decrease: 9.50 degrees, 95% confidence interval: -11.47 to -7.52), indicating effective deformity correction. Heterogeneity was observed across studies, likely attributed to variations in surgical techniques and measurement methods. Conclusions: LLIF demonstrates efficacy in adult scoliosis management, with favorable outcomes in terms of deformity correction and functional improvement. The minimally invasive nature of LLIF contributes to reduced surgical morbidity and accelerated recovery, underscoring its significance as an alternative to traditional open surgery of the lumbar spine. Limitations include heterogeneity present across studies, which warrant continued research to evaluate these outcomes. Nevertheless, LLIF holds promise as an effective surgical approach.