Abstract
Oblique lateral lumbar interbody fusion (OLLIF) is a novel operation for fusions of the lumbar spine from T12–S1. In OLLIF, the disk is approached from an oblique lateral angle guided by electrophysiological monitoring and biplanar fluoroscopy; the disk space is accessed through Kambin’s triangle. We present perioperative, clinical, patient-reported and radiological outcomes from a series of 303 OLLIF procedures on 568 levels performed by the same surgeon. For a single-level OLLIF, mean surgery time was 56.6 ± 37.7 minutes, with a blood loss of 42.2 ± 31.1 mL, fluoroscopy time of 198.8 ± 87.2 seconds and a hospital stay of 2.2 ± 1.7 days. At the one-year follow-up, 10-point pain scale scores improved from 8.6 ± 1.3 to 4.1 ± 3.0 (p < 0.001). Total Oswestry disability index score improved from 56.6% ± 15.3% to 38.6% ± 21.4% (p < 0.001). At the one-year follow-up, 15 (5%) patients had mild nerve root irritation defined as sensory symptoms and motor weakness better than 4/5. Only one patient had neuropraxia due to weakness (3/5). There was one case (0.3%) of superficial wound infection and one case of bleeding into the psoas major. Reoperation within one year was performed for 14 (4.7%) patients. Interbody fusion was achieved in 98.7% of levels. While OLLIF has previously been described, this study is the first to present clinical, patient-reported, and radiological outcomes of OLLIF. Review of the literature shows that OLLIF produces perioperative outcomes, complication rates, and fusion rates that compare favorably with similar procedures. We establish that OLLIF is a safe, efficient and efficacious procedure for fusions of the lumbar spine.
Highlights
Low back pain is the most common source of years lived with disability worldwide and has a point prevalence of up to 30% in the United States [1]
Linear regression shows that controlling for the number of levels, there is no significant impact of body mass index (BMI) on surgery time (OLS coefficient 0.23, 95% CI -0.15 to 0.61) and that each additional level of surgery increases surgery time by 24.9 minutes
We previously showed that Oblique lateral lumbar interbody fusion (OLLIF) is faster than Transforaminal lumbar interbody fusion (TLIF) performed by the same surgeon, with a 69-minute decrease in surgery time for single-level procedures and larger differences for multilevel procedures [12]
Summary
Low back pain is the most common source of years lived with disability worldwide and has a point prevalence of up to 30% in the United States [1]. Low back pain is commonly caused by degenerative changes to the spine, including the intervertebral disk and facet joints. Degenerative disc and facet disease leads to progressive disability by causing disc herniation and nerve entrapment, and changes at a single level often lead to a multilevel disease [2]. As the prevalence of degenerative spine disease has increased, demand for surgical treatments and the associated costs have skyrocketed [1,3]. Considering these realities, advances in the surgical treatment of disc disorders have the potential to improve outcomes for millions of patients and significantly reduce overall health care costs
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