Standalone oblique lumbar interbody fusion versus oblique lumbar interbody fusion with posterior pedicle screw fixation for lumbar degenerative disease: A systematic review and meta-analysis

Abstract

Oblique lumbar interbody fusion (OLIF) may be performed alone or with posterior pedicle screw fixation (PSF), but the trade-off between operative burden and mechanical durability remains uncertain. We compared perioperative, clinical, fusion, and cage-subsidence outcomes after standalone OLIF and OLIF+PSF in patients with lumbar degenerative disease. PubMed/MEDLINE, ScienceDirect, and ClinicalKey were searched and updated through August 24, 2026, with citation chasing. Eight reports representing seven unique cohorts included 447 patients. Standalone OLIF was associated with shorter operative time (mean difference [MD], −79.33 min; 95% confidence interval [CI], −119.91 to −38.75; I 2 = 97%) and less blood loss (MD, −26.41 mL; 95% CI, −49.55 to −3.28; I 2 = 96%), although heterogeneity was extreme. Early back pain favored standalone OLIF; later back pain and disability were similar. Leg pain at ≥1 year favored OLIF+PSF (MD, 0.69; 95% CI, 0.10–1.27; I 2 = 57%), but this was based on few studies. Fusion occurred in 191/204 (93.6%) standalone and 167/170 (98.2%) OLIF+PSF patients; the pooled OR was 3.70 (95% CI, 1.16–11.11). OLIF+PSF was associated with lower odds of reported cage subsidence (OR, 0.18; 95% CI, 0.11–0.31), although definitions and denominators varied. Certainty was low or very low. Standalone OLIF appears to reduce operative burden, whereas PSF may improve mechanical durability; selection should be individualized.