Supine ALIF versus Lateral-Decubitus OLIF for Degenerative Lumbar Disease: A Systematic Review and Meta-Analysis of Comparative Studies.

Spine (Phila Pa 1976) · Oct 15 2026 · Recent

Shah ID, Sadh P, Sharma V, Mahmoud T, Daniels AH, Basques BA

Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University

Spine

SUMMARY — THE REDUCTIONIn 13 comparative studies (1,432 patients), OLIF had shorter hospital stay and greater sagittal vertical axis correction than supine ALIF, with similar complications and patient-reported outcomes, including in fusions to the sacrum.
Abstract, as published

OBJECTIVE: To compare outcomes between supine anterior lumbar interbody fusion (ALIF) and lateral decubitus oblique lumbar interbody fusion (OLIF).

BACKGROUND: ALIF and OLIF differ in surgical corridor and patient positioning, with their relative advantages remaining debated.

METHODS: A PRISMA-compliant search of PubMed, Embase, and Google Scholar was performed through April 2026 for studies evaluating anterior versus oblique lumbar interbody fusion. Outcomes included perioperative, complication, patient-reported, and sagittal alignment measures, pooled using fixed- or random-effects models based on heterogeneity (I²>50%).

RESULTS: Thirteen studies (1,432 patients; 795 ALIF, 637 OLIF) met inclusion criteria. OLIF was associated with shorter length of stay (-0.87 days [95% CI: -1.47 to -0.26], P=0.005). Leave-one-out analyses demonstrated lower operative time (-39.07 minutes [95% CI: -76.73 to -1.41], P=0.04) and estimated blood loss (-96.32 mL [95% CI: -182.03 to -10.61], P=0.03) favoring OLIF, though substantial heterogeneity persisted. Complications and patient-reported outcomes did not differ. OLIF showed greater reductions in sagittal vertical axis (SVA) immediately postoperatively (-18.32 mm [95% CI: -30.89 to -5.75], P=0.004) and at final follow-up (-9.39 mm [95% CI: -17.83 to -0.96], P=0.03). In a subanalysis of fusions involving the sacrum, OLIF had lower EBL (-182.32 mL [95% CI: -297.38 to -67.27], P=0.002) and shorter LOS (-1.45 days [95% CI: -1.72 to -1.18], P<0.00001), with a similar operative time trend (-72.83 min [95% CI: -147.48 to 1.81], P=0.06).

CONCLUSIONS: OLIF appears to offer a modest advantage over ALIF, with shorter hospitalization, comparable complications and patient-reported outcomes, and greater SVA correction. These perioperative benefits could potentially be meaningful in patients with higher comorbidity burden and appeared preserved in fusions involving the sacrum. The SVA correction may reflect advantages of single-position lateral surgery for restoring global alignment.

STUDY DESIGN: Systematic review and meta-analysis.

LEVEL OF EVIDENCE: III.

Read the article: PubMed · Publisher (DOI)

Featured in the 2026-10-22 issue.

← Hip Spine Syndrome: Management of Patients With Concurrent Hi…Outcomes Related to the Use of Standard-Standard versus Stand… →

The Reduction is a free email digest of newly published orthopaedic literature — a handful of new papers in the subspecialties you choose, each summarized like this one. Subscribe free or browse the archive.