Abstract
Purpose A retrospective imaging study assessing the availability of oblique lumbar interbody fusion at the level of L5-S1 (OLIF51) and to choose ideal surgical corridor in OLIF51 by introducing V-line. Methods The axial views through the center of L5-S1 disc were reviewed. We adopt 18 mm as the width of the simulated surgical corridor. The midline of the surgical corridor is at the center of L5-S1 disc. According to the traction distance of the left iliac vein (LCIV) and psoas major (PM), we defined all the subjects as V (+) (traction-difficultly LCIV), V (-) (traction-friendly LCIV), P (+) (traction-difficultly PM), and P (-) (traction-friendly PM). V-line was defined as a straight line dividing equally the simulated surgical corridor. All cases were divided into 2 groups: The V-line (+) group, more than half of the LCIV region, is located in the ventral part of V-line; the V-line (-) group, more than half of the LCIV region, is located in the dorsal part of V-line. Multiple variables regressive analysis was conducted to analyze the independent risk factors of V-line (+). Results V-line (+) was found in 36 (38.7%) patients and V-line (-) in 57 (61.3%). Incidence of V (+) and P (+) was 35.4% (33/93) and 30.1% (28/93), respectively. 16.1% (15/93) subjects processed V (+) and P (+) at the same time. The independent risk factor of V-line (+) were gender of male (P = 0.034, OR: 12.152) and medial position of LCIV (P < 0.001, OR: 265.085). High iliac crest was a significant independent protective factor (P = 0.001, OR: 0.750). Conclusions Most patients were suitable for OLIF51. V-line could assess the injury risk of LCIV. For patients who are V-line (+), mainly among males having the LCIV near the midline or the iliac crest relatively low, a surgical corridor external to the LCIV should be taken into consideration.
Highlights
The oblique interbody fusion (OLIF), as a new type of minimally invasive technique, has good applicability at L2-L5
Significant difference was found between gender and the left iliac vein position
OLIF51 is considered as minimally invasive Anterior lumbar interbody fusion LLIF (ALIF) through the oblique corridor in the lateral position [10]. It keeps the advantages of traditional ALIF with direct and extensive exposure of the intervertebral disc and avoidance of neural and muscular injury compared with the posterior approach
Summary
The oblique interbody fusion (OLIF), as a new type of minimally invasive technique, has good applicability at L2-L5. It has a wide range of indications including lumbar degenerative disease, spinal deformities, trauma, infections, and neoplasms [1]. As with ALIF and LLIF, it avoids iatrogenic injury to the paraspinal musculature and disruption of spinal canal [2] This surgical technique allows access to the anterolateral margin of the vertebral body between the psoas major and abdominal aorta, reducing the lumbar plexus injury during LLIF and abdominal large vessel injury during ALIF [3]. OLIF should be carefully chosen in clinical indications [4,5,6]
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