Objective: This study compared the radiological and clinical outcomes with transforaminal lumbar interbody fusion (TLIF) to evaluate the effect of indirect decompression through oblique lumbar interbody fusion (OLIF) as revision surgery.Methods: We enrolled patients who underwent single-level fusion with revision surgery at the same level as the previous decompression level. We retrospectively reviewed 25 patients who underwent OLIF from 2017 to 2018 and 25 who received TLIF from 2014 to 2018. Radiologic and clinical outcomes were evaluated by cross-sectional area (CSA) of the spinal canal, thickness and area of ligamentum flavum (LF), subsidence, disc height, fusion rate, Oswestry Disability Index (ODI), and visual analogue scale (VAS).Results: Compared with OLIF, the thickness and area of the LF after surgery were significantly less in TLIF, and the resulting CSA extension was also significantly higher. However, both groups showed improvement in ODI and VAS after surgery, and there was no difference between the groups. Complications related to the posterior approach in TLIF were 4 cases, and in OLIF, there were 2 cases that underwent additional posterior decompression surgery and 6 cases of transient paresthesia.Conclusion: Since complications associated with the posterior approach can be avoided, OLIF is a safer and useful minimally invasive surgery. Therefore, appropriate indications are applied, OLIF is a good alternative to TLIF when revision surgery is considered.

Purpose To develop an artificial intelligence framework, robust to spinal implants, for automated measurement of spinopelvic parameters on postoperative radiographs. Materials and Methods Lateral lumbar spine radiographs from two institutions (internal dataset [ n = 2486]: January 2017-December 2024; external dataset [ n = 217]: October 2021-September 2025) were retrospectively reviewed. The Restore, Segment, and Measure (RSM) framework was developed, incorporating a novel Artifact Removal Network based on Autoencoding and Inpainting (ARNAI) to mitigate implant-related artifacts. Segmentation and spinopelvic parameter (including segmental Cobb angle [SCA]) measurement performance relative to expert reference measurements were assessed using the Dice similarity coefficient (DSC), mean absolute error (MAE), Wilcoxon signed-rank tests, and Benjamini-Hochberg correction for multiple comparisons. Results With ARNAI added to the segmentation pipeline, the mean DSC increased to 0.870 from 0.814, with marked gains at L3-L5. For implant-containing radiographs in the internal test set, rejected radiographs decreased by 64.21% (95 to 34), and the L4-L5 SCA MAE decreased to 4.7° from 16.2°-15.6° (~ 70% reduction); this remained significant after correction. For the external test set, rejected radiographs decreased by 65.45% (110 to 38), and the L4-L5 SCA MAE decreased to 9.5°-9.7° from 14.2°-14.5° (~ 33% reduction); however, this improvement did not remain significant after correction, and agreement with expert references remained limited. Conclusion The RSM framework improved automated spinopelvic parameter measurement in implant-containing postoperative radiographs, with the greatest benefit observed for L4-L5 SCA estimation in the internal dataset. In the external dataset, error was reduced but agreement remained limited. © RSNA, 2026