OLIF versus TLIF for multilevel lumbar stenosis in older patients
BMC Musculoskeletal Disorders · 19 Oct 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
Choosing between indirect lateral decompression and direct posterior decompression is a common decision in elderly multi-level stenosis, and this study suggests, without proving, that OLIF may ease early recovery.
The evidence
This single-centre retrospective cohort compared oblique lateral interbody fusion (OLIF, n=33) with transforaminal lumbar interbody fusion (TLIF, n=46) in patients older than 65 with multi-level lumbar spinal stenosis, all managed under the same ERAS pathway. OLIF patients lost less blood (about 423 vs 665 mL), went home sooner (6.6 vs 9.0 days), and had higher adjusted odds of reaching a clinically meaningful 2-year ODI improvement (OR 1.53, 95% CI 1.02 to 2.31). Several crude differences, such as transfusion and urinary infection rates, were no longer significant after adjustment.
Achievement of MCID for ODI at 2-year follow-up: Odds ratio 1.53 (95% CI 1.02 to 2.31; ODI). The interval favours the first group; the size of the benefit needs clinical interpretation.
Why this rigour score?
Prospective cohortDesign starting point: 40
Raised the score
- Blinded outcome assessment+6.8
- Compared against current standard of care+3.4
Lowered the score
- A single centre's own patients−3.4
Methods at a glance
Recorded assessment- Confounding adjustmentMultivariable regression
- Covariate balance confirmedNot applicable
- Outcome assessors blindedMet
- Comparable start of follow-upMet
- Adequate statistical powerCalculation absent
- Prospective registrationNot met
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
See the full score breakdown
- Study design starting point
- 40
- Aligned time zero
- +2.5
- Compared against current standard of care
- +3.4
- Blinded outcome assessment
- +6.8
- 24-month follow-up
- +3.4
- A single centre's own patients
- −3.4
- Consecutive enrolment
- +2.5
- Journal prior (not an observed method)
- +0.4
- Final rigour score rounded
- 56 / 100
Study design sets the starting point and a ceiling of 82. Recorded methods then adjust the score. Points are shown to one decimal place; the final score uses unrounded values.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.Which anatomical and clinical features (for example, bony lateral recess stenosis, facet hypertrophy, or severe osteoporosis) would make you favour direct TLIF decompression over indirect OLIF decompression in an older patient with multi-level stenosis?
2.How would you counsel a frail 72-year-old about the trade-off between a staged lateral plus posterior OLIF procedure and a single-position TLIF in terms of recovery time, transfusion risk, and postoperative leg numbness or weakness?
Original publication title
Comparative evaluation of perioperative outcomes and radiographic findings in older patients undergoing TLIF versus OLIF surgeries for multi-level lumbar spinal stenosis