Advances in the mechanisms and nursing strategies for sympathetic abdominal distension following oblique lateral interbody fusion

Minimally invasive oblique lateral lumbar interbody fusion (OLIF) is one of the mainstream minimally invasive surgical procedures commonly used to treat degenerative lumbar disorders. This technique is associated with limited surgical trauma, reduced intraoperative blood loss, minimal impact on intrinsic spinal stability, and faster postoperative recovery, and it has therefore been increasingly adopted in clinical spinal surgery. OLIF is performed through a relatively safe corridor within the retroperitoneal space, anterior to the psoas major muscle and between the psoas major and the major abdominal vessels. Although this surgical approach is considered relatively safe, the operative field lies in close proximity to the lumbar sympathetic chain and lumbar plexus. Intraoperative traction, retraction, electrocautery, and postoperative compression caused by local hematoma may all induce sympathetic nerve dysfunction, thereby leading to sympathetic abdominal distension. Once sympathetic abdominal distension occurs, it may prolong postoperative recovery, increase patient discomfort and hospitalization costs, and reduce patient satisfaction. This article systematically summarizes the anatomical basis, pathogenesis, key points of clinical assessment, and differential diagnosis of sympathetic abdominal distension after OLIF. It also reviews relevant strategies, including perioperative predictive nursing interventions based on pathogenic mechanisms, traditional Chinese medicine nursing techniques, multidisciplinary collaborative management, and intraoperative nerve protection. In addition, current limitations in existing research and future directions are discussed, with the aim of providing a reference for developing standardized, precise, and evidence-based nursing protocols, reducing the incidence of this complication, and promoting the practical implementation of enhanced recovery concepts in spinal surgery.