{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T16:00:43Z","timestamp":1785427243826,"version":"3.56.0"},"reference-count":26,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T00:00:00Z","timestamp":1776902400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","award":["RS-2025-24683650"],"award-info":[{"award-number":["RS-2025-24683650"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]},{"award":["RS-2025-24683650"],"award-info":[{"award-number":["RS-2025-24683650"]}],"id":[{"id":"https:\/\/ror.org\/013aysd81","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Ureteral complications following oblique lumbar interbody fusion (OLIF) are uncommon and are typically attributed to direct mechanical injury. Functional ureteral obstruction without overt ureteral damage remains poorly characterized. We report two cases that provide clinical and intraoperative evidence of a previously underrecognized mechanism of ureteral obstruction associated with anterior cage positioning during OLIF. Case Presentation: Among 180 OLIF procedures performed by a single surgeon, two cases (1.1%) of postoperative or intraoperative ureteral compromise without direct structural injury were identified. In the first case, postoperative imaging revealed hydronephrosis and focal angulation of the left proximal ureter at the level of the interbody cage, without contrast extravasation. The obstruction was managed with double-J ureteral stenting, and serial renal function monitoring confirmed preserved renal function throughout the clinical course. In the second case, retroperitoneal tissue including the ureter was directly observed intraoperatively to be interposed between the anterior longitudinal ligament and the interbody cage during anterior cage placement. Release of the interposed tissue resulted in immediate ureteral decompression without structural damage. Correlation of the postoperative findings in the first case with the intraoperative observations of the second case supports a unified mechanistic explanation: anterior cage advancement may draw retroperitoneal tissue into the cage\u2013anterior longitudinal ligament interface, subjecting the ureter to focal compression or angulation. Conclusions: Functional ureteral obstruction during OLIF may occur secondary to retroperitoneal tissue interposition rather than direct ureteral trauma. Awareness of this mechanism and meticulous protection of the anterior retroperitoneal layer during cage advancement may help prevent avoidable ureteral complications.<\/jats:p>","DOI":"10.3390\/jcm15093235","type":"journal-article","created":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T17:04:59Z","timestamp":1776963899000},"page":"3235","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Functional Ureteral Obstruction Due to Retroperitoneal Tissue Interposition During Oblique Lumbar Interbody Fusion: A Report of Two Cases"],"prefix":"10.3390","volume":"15","author":[{"given":"Jun-Seok","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Eunpyeong St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1237-4600","authenticated-orcid":false,"given":"Young-Hoon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2758-0012","authenticated-orcid":false,"given":"Sang-Il","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2510-280X","authenticated-orcid":false,"given":"Kihyun","family":"Kwon","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0712-9152","authenticated-orcid":false,"given":"Sangjun","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9351-1616","authenticated-orcid":false,"given":"Joonghyun","family":"Ahn","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Bucheon St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Bucheon 14647, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6138-1527","authenticated-orcid":false,"given":"Chungwon","family":"Bang","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Incheon St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Incheon 21431, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0084-8867","authenticated-orcid":false,"given":"Hyung-Youl","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Eunpyeong St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"112","DOI":"10.31616\/asj.2024.0310","article-title":"Which subtypes of degenerative lumbar spondylolisthesis are suitable for oblique lumbar interbody fusion? 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