Standalone lateral and oblique approaches vs traditional posterior approaches for adjacent segment disease: A systematic review and meta-analysis.

In 30 seconds

This systematic review and meta-analysis compared lateral or oblique standalone cages with posterior approaches for lumbar adjacent segment disease. Eight studies involving 281 patients were included. Compared with posterior surgery, standalone procedures were associated with lower estimated blood loss, shorter operative time and hospital stay, greater change in disc height, and lower odds of complications. The principal trade-off was higher cage subsidence odds with standalone cages (OR = 4.65, 95% CI: (1.24, 17.37) p = 0.02). The authors reported similar radiological and clinical outcomes overall.

Key findings

• Standalone cages were associated with lower estimated blood loss (MD:-311.66 ml, (95% CI:-351.61, -271.72) p < 0.001).
• Operative time and hospital stay were shorter with standalone cages (MD:-85.14 min, (95% CI:-105.97, -64.32) p < 0.001; MD:-3.23 days, (95%CI: -4.65,-1.80) p < 0.001).
• Complication odds were lower with standalone cages (OR = 0.38, 95% CI: (0.17, 0.88) p = 0.02), while subsidence odds were higher (OR = 4.65, 95% CI: (1.24, 17.37) p = 0.02).
• Standalone cages produced a greater change in disc height (MD:1.6 mm, (95% CI: 0.67, 2.68) p = 0.001); overall radiological and clinical outcomes were reported as similar.

Why it matters

The findings highlight a potential trade-off when selecting an approach for lumbar adjacent segment disease: standalone cages were associated with less perioperative burden and fewer complications, but more subsidence. This distinction can inform balanced discussion of procedural options and risks, while the evidence base remains limited to eight studies and does not establish that one approach is preferable for every patient.

What to keep in mind

The review included only eight studies and 281 patients; the abstract does not specify whether the included studies were randomised.