The mono- and multisegmental ventral minimally invasive approach to the lumbar spine (OLIF) in lumbar deformities

Abstract

Minimally invasive anterolateral approach to the lumbar spine (oblique lateral interbody fusion, OLIF) to correct lumbar deformities. Ventral release in degenerative lumbar scoliosis or segmental kyphosis and intervertebral spondylodesis. No absolute contraindications. Relative contraindications are previous (left-sided) retroperitoneal interventions or status after peritonitis with pronounced retroperitoneal scarring. Vascular anomalies with extremely lateral common iliac vein (especially with segmentation disorders in the penultimate mobile segment). Through asmall skin incision in the left abdominal wall and alternating incision technique through the abdominal wall muscles retroperitoneal approach to the lateral anterior lumbar spine monosegmental or from L1-L5 multisegmental if needed. Retraction of the psoas muscle and removal of the intervertebral disc space, if necessary with resection of the anterior longitudinal ligament. Intervertebral release and interposition of an implant for ventral spondylodesis. Early mobilisation after dorsal instrumentation under thrombosis prophylaxis. Light meals until the first bowel movement. Wearing atrunk stabilizing brace for up to 12weeks, depending on the type and extent of the procedure. No limitations regarding walking distance, standing and sitting immediately postoperatively. In all, 15patients with degenerative lumbar scoliosis were treated with ventrodorsal fusion surgery. The surgical anterior treatment included 1-4segments. The access-specific complications and pre- and postoperative radiological parameters were recorded. None of the 15left-sided retroperitoneal ventral accesses showed intraoperative or postoperative access-specific complications. Asignificant reduction of the anteroposterior Cobb angle from 16° ± 6° preoperatively to 3° ± 2° postoperatively (p < 0.001) was achieved in the entire patient population.