Neutral hip position for the oblique lumbar interbody fusion (OLIF) approach increases the retroperitoneal oblique corridor

Vit Kotheeranurak,Chindarat Ratanakornphan,Worawat Limthongkul,Weerasak Singhatanadgige,Richard A Hynes,Wicharn Yingsakmongkol

doi:10.1186/s12891-020-03592-9

Vit Kotheeranurak, Chindarat Ratanakornphan + Show 4 more

Open Access

https://doi.org/10.1186/s12891-020-03592-9

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Abstract

BackgroundThe prepsoas lateral approach for spinal fusion, oblique lateral lumbar interbody fusion (OLIF), is considered one of the minimally invasive spinal fusion methods and is gaining popularity due to improved outcomes with copious supporting evidence. To date, no publication has studied the various positions of the left hip in actual patients which might affect the retroperitoneal oblique corridor (ROC). The study aimed to find the relevancy of the left hip position and the size of ROC.MethodsWe recruited 40 consecutive patients who needed diagnostic MRI from the out-patient clinic. MRI scan from L2 to L5 was performed in the supine, right lateral decubitus with hip flexion, and right lateral decubitus with hip in a neutral position. The retroperitoneal oblique corridor (ROC) was measured at the intervertebral disc level and compared.ResultsROC of the hip in neutral position was significantly larger than hip flexion in all levels (p < 0.05); there was no significant difference in the ROC among levels (p = 0.22). ROC seems to be largest at L2/3 followed by L3/4 and L4/5 respectively in all positions.ConclusionsThe retroperitoneal oblique corridors of L2 to L5 were significantly increased when the hip is in the neutral position, while the psoas cross-sectional area and anterior thickness were minimized in this position. Surgeons might benefit from a neutral position of the left hip in the oblique lateral lumbar interbody fusion (OLIF) procedure.

Highlights

The prepsoas lateral approach for spinal fusion, oblique lateral lumbar interbody fusion (OLIF), is considered one of the minimally invasive spinal fusion methods and is gaining popularity due to improved outcomes with copious supporting evidence
There is no strict rule on how the left hip should be positioned and no publication has studied the various positions of the left hip which might affect the retroperitoneal oblique corridor (ROC)
Measured at the mid-intervertebral disc height, we described the ROC at each level as the distance between A and B, where A was the left-most lateral border of the aorta, and B was the most anteromedial aspect of the left psoas muscle (Fig. 1)

Summary

Introduction

The prepsoas lateral approach for spinal fusion, oblique lateral lumbar interbody fusion (OLIF), is considered one of the minimally invasive spinal fusion methods and is gaining popularity due to improved outcomes with copious supporting evidence. The lumbar spine MRI images in the supine position are used to determine the presence of the retroperitoneal oblique corridor (ROC), located between the aorta or the left common iliac artery and the left psoas muscle, to ensure safety and reduce complications during the surgery [7,8,9,10]. This ROC passage allows the surgeon to perform the intervertebral disc. We hypothesized that the ROC would be affected by the position of the left hip in the right lateral decubitus position

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