Oblique Lumbar Interbody Fusion Procedures Research Articles

Quantitative Threshold of Intraoperative Radiological Parameters for Suspecting Oblique Lumbar Interbody Fusion Cage Malposition Triggering Contralateral Radiculopathy.

This study aimed to clarify the quantitative threshold of intraoperative radiological parameters for suspecting posterior malposition of the oblique lumbar interbody fusion (OLIF) cage triggering contralateral radiculopathy. We measured the sagittal center and axial rotation angle (ARA) of the cage using postoperative computed tomography (CT) in 130 patients (215 cages) who underwent OLIF. The location of the cage tip was determined from axial magnetic resonance imaging in selected cases based on CT simulations to assess whether the cage was in contact with the contralateral exiting nerve or whether the surgical instruments could contact the nerve during intradiscal maneuvers. The sagittal center of the cages was on average 41.5% from the anterior edge of the endplate (shown as AC/AP value: anterior end plate edge-cage center/anterior-posterior endplate edge ×100%), and posterior cage positioning ≥50% occurred in 14% of the cages. The ARA was -2.9°, and posterior oblique rotation of the cages ≥10° (ARA ≤ -10°) was observed in 13%. CT simulation showed that the cage tip could directly contact the contralateral nerve when the cage was placed deep in the posterior portion ≥50% of the AC/AP values with concomitant posterior axial rotation ≥10° (ARA ≤ -10°), or deep in an extremely rare portion ≥60% of the AC/AP values with posterior axial rotation ≥0° (ARA ≤ 0°). Six percent of the cages (13/215) were placed in these posterior oblique areas (potential contact area: PCA). Three cages in the PCA were in direct contact with the contralateral nerves, and 9 were placed deep just anterior to the nerves. Symptomatic contralateral radiculopathy occurred in 2 cages (2/13/215, 15.3%/0.9%). Two intraoperative radiological parameters (AC/AP and ARA) measurable during OLIF procedures may become practical indicators for suspecting cage malposition in PCA and may be available when determining whether to consider cage revision intraoperatively to a more ventral disc space or anteriorly from the opposite endplate edge.

Research Progress of the Anatomical Structure of the Surgical Approach for Oblique Lumbar Interbody Fusion

Oblique Lumbar Interbody Fusion (OLIF) is a newly developed minimally invasive lumbar interbody fusion procedure used to treat a variety of degenerative lumbar spine diseases. The OLIF procedure has the advantages of less trauma, less bleeding, faster recovery, significant indirect decompression, large bone graft area, high fusion rate, and preservation of posterior column structures, but it needs to be performed under the condition of familiarity with the patient's anatomical approach to avoid injury to nerves, blood vessels, and other structures. In this paper, we review the new clinical advances in the application of anatomy for OLIF surgery in terms of the abdominal wall, blood vessels, lumbar major muscle, window between blood vessels and lumbar major muscle, nerves, and ureter.

Contralateral lower limb radiculopathy by extraforaminal disc herniation following oblique lumbar interbody fusion in degenerative lumbar disorder: illustrative cases.

Contralateral lower limb radiculopathy is a potential early complication of oblique lumbar interbody fusion (OLIF) in degenerative lumbar disorders. Among several pathologies related to contralateral radiculopathy following OLIF, extraforaminal disc herniation during the OLIF procedure is very rare. Case 1 is a 68-year-old male underwent L4-5 and L5-6 OLIF for recurrent lumbar canal stenosis-expressed right leg pain and muscle weakness after surgery. Case 2 is a 76-year-old female on whom L4-5 OLIF was performed for L4 degenerative spondylolisthesis and who presented right leg pain and numbness postoperatively. In both patients, OLIF cages were inserted into the posterior part of the disc space or obliquely and the extraforaminal extruded disc compressed opposite exiting nerve roots (L5 root in case 1 and L4 root in case 2) as shown on magnetic resonance imaging (MRI). Surgical decompression with discectomy was required for pain relief and neurological improvement in both cases. When emerging from new-onset opposite limb radiculopathy attributed to the OLIF procedure, extraforaminal disc herniation should be considered a potential pathology and MRI is useful for early diagnosis and selecting a subsequent management, including surgery.

Acceptable Fusion Rate of Single-Level OLIF Using Pure Allograft Combined with Posterior Instrumentation through the Wiltse Approach: A 2-Year Follow-Up Study.

Autogenic bone grafts have shown successful fusion rates in the treatment of degenerative lumbar disorders, but taking too many autogenic bones may result in donor site ischemia or infection. This study aimed to evaluate the outcomes of single-level oblique lumbar interbody fusion (OLIF) using pure allograft combined with posterior pedicle screw instrumentation through the Wiltse approach. A retrospective case analysis was performed on a series of consecutive patients who received a single-level OLIF procedure combined with posterior pedicle screw instrumentation through the Wiltse approach between July 1, 2017, and December 31, 2019, in which pure allogenic bone graft was used and filled in the large window of the cage. The patients were followed up as scheduled at 1 day and 3, 6, 12, 24months after operation. Clinical outcome was assessed by multiple questionnaires, including Oswestry disability index (ODI), Japanese Orthopaedic Association (JOA) score rating system, short form-36 health survey (SF-36), and visual analog scale (VAS) for low back pain. Radiographic outcome was evaluated by measuring the parameters such as disc height, lumbar lordosis, and segmental angle on the standard standing lateral radiographs, and the space angle of the fusion level on the dynamic views of the lateral radiographs. Subsidence of the cage and intervertebral fusion status were evaluated on both the radiographic and CT scan images. A total of 34 patients were finally included in this study. At 2-year follow-up, the VAS for low back pain, ODI, JOA, and SF-36 scores all had significant improvement (p < 0.001). Substantial increase of anterior and posterior disc heights was observed (p < 0.001). Both lumbar lordosis and segmental angle became larger (p < 0.05). No visible change of the space angle of the fusion level was found on the dynamic views. The 1-year fusion rate of 73.5% on CT scans proceeded to 82.4% at 2-year follow-up. The fusion rate was as high as 91.2% according to Bridwell interbody fusion grading system on radiographic images. The clinical outcomes in patients with incomplete fusion were just as good as those with complete fusion. The six patients with cage subsidence had higher ODI (p < 0.001) and lower JOA (p < 0.001) and SF-36 PCS (p=0.011) scores than those without cage subsidence. The use of pure allograft in single-level OLIF resulted in an acceptable fusion rate and satisfactory clinical effect at 2-year follow-up. Supplementation of posterior pedicle screw through the minimally invasive Wiltse approach ensured the favorable outcomes both clinically and radiographically.

Prevalence and location of endplate fracture and subsidence after oblique lumbar interbody fusion for adult spinal deformity

BackgroundRecently, Oblique lumbar interbody fusion (OLIF) is commonly indicated to correct the sagittal and coronal alignment in adult spinal deformity (ASD). Endplate fracture during surgery is a major complication of OLIF, but the detailed location of fracture in vertebral endplate in ASD has not yet been determined. We sought to determine the incidence and location of endplate fracture and subsidence of the OLIF cage in ASD surgery, and its association with fusion status and alignment.MethodsWe analyzed 75 levels in 27 patients were analyzed using multiplanar CT to detect the endplate fracture immediately after surgery and subsidence at 1 year postoperatively. The prevalence was compared between anterior and posterior, approach and non-approach sides, and concave and convex side. Their association with fusion status, local and global alignment, and complication was also investigated.ResultsEndplate fracture was observed in 64 levels (85.3%) in all 27 patients, and the incidence was significantly higher in the posterior area compared with the anterior area (85.3 vs. 68.0%, p=0.02) of affected vertebra in the sagittal plane. In the coronal plane, there was no significant difference in incidence between left (approach) and right (non-approach) sides (77.3 and 81.3%, respectively), or concave and convex sides (69.4 and 79.6%) of wedged vertebra. By contrast, cage subsidence at 1 year postoperatively was noted in 14/75 levels (18.7%), but was not associated with endplate fracture. Fusion status, local and global alignment, and complications were not associated with endplate fracture or subsidence.ConclusionEndplate fracture during OLIF procedure in ASD cases is barely avoidable, possibly induced by the corrective maneuver with ideal rod counter and cantilever force, but is less associated with subsequent cage subsidence, fusion status, and sustainment of corrected alignment in long fusion surgery performed even for elderly patients.

The Effect of Oblique Lumbar Interbody Fusion Compared with Transforaminal Lumbar Interbody Fusion Combined with Enhanced Recovery after Surgery Program on Patients with Lumbar Degenerative Disease at Short-Term Follow-Up.

Purpose Oblique lumbar interbody fusion (OLIF) approach has been increasingly frequently performed in recent years. However, neither studies of OLIF approach nor the researches of the application of enhanced recovery after surgery (ERAS) in spinal surgery are relatively rare. Here, our study is aimed at investigating the therapeutic effects of the application of OLIF compared with transforaminal lumbar interbody fusion (TLIF) approach combined with ERAS in dealing with this disorder at short-term follow-up. Material and Methods. Thirty-eight patients who undergone OLIF and forty patients who undergone TLIF with pedicle screws were included in our study. The concept of ERAS was applied in the perioperative period of the patients. Preoperative and postoperative laboratory test indexes of blood were examined and evaluated in all individuals. Visual analogue scale (VAS), Oswestry disability index (ODI), and Clinical Symptom Score of the Japanese Orthopaedic Association (JOA) were used in preoperative evaluation and postoperative follow-up. Satisfaction survey was also performed after surgery. Result The postoperative results of red blood count, C-reaction protein, D-dimer, and albumin were still within the reference ranges in most of the patients. It was shown that objective evaluations including VAS score, ODI index, and JOA score were significantly improved after OLIF and TLIF surgery. The follow-up of 6 months after surgery showed that VAS, ODI, and JOA were improved more in the OLIF group than that in the TLIF group. The overall satisfaction (satisfied and very satisfied) was 95% and 97.4% in the TLIF group and the OLIF group, respectively, and there was no difference between the two groups. Conclusion This study indicated that OLIF and TLIF approach were both rather effective therapies for patients with lumbar degenerative diseases. The effect of OLIF procedure could be better than TLIF procedure in the early stage after surgery.

Oblique Lumbar Interbody Fusion from the Right-Side Approach in the Treatment of a Patient with Left-Sided Inferior Vena Cava

Oblique lumbar interbody fusion (OLIF) can achieve better reconstruction of the lumbar spine via the anatomic corridor between the psoas muscle and the great vessels. Despite OLIF is considered as an effective and relatively safer procedure, congenital anomalies of the main vessels surrounding the oblique corridor may pose higher risk of vascular damage, which should bear in mind in deciding to use the OLIF procedure. We presented a case of an anomalous left-sided inferior vena cava (IVC) who underwent an OLIF procedure alternatively through a larger corridor between the aorta and the right psoas muscle. The lumbar sympathetic trunk (LST) could be observed and subsequently protected at the medial border of the right psoas muscle.

Posterior fixation can further improve the segmental alignment of lumbar degenerative spondylolisthesis with oblique lumbar interbody fusion

BackgroundFor patients with degenerative spondylolisthesis, whether additional posterior fixation can further improve segmental alignment is unknown, compared with stand-alone cage insertion in oblique lumbar interbody fusion (OLIF) procedure. The aim of this study was to compare changes of the radiographical segmental alignment following stand-alone cage insertion and additional posterior fixation in the same procedure setting of OLIF for patients with degenerative spondylolisthesis.MethodsA retrospective observational study. Selected consecutive patients with degenerative spondylolisthesis underwent OLIF procedure from July 2017 to August 2019. Five radiographic parameters of disc height (DH), DH-Anterior, DH-Posterior, slip ratio and segmental lordosis (SL) were measured on preoperative CT scans and intraoperative fluoroscopic images. Comparisons of those radiographic parameters prior to cage insertion, following cage insertion and following posterior fixation were performed.ResultsA total of thirty-three patients including six males and twenty-seven females, with an average age of 66.9 ± 8.7 years, were reviewed. Totally thirty-six slipped levels were assessed with thirty levels at L4/5, four at L3/4 and two at L2/3. Intraoperatively, with only anterior cage support, DH was increased from 8.2 ± 1.6 mm to 11.8 ± 1.7 mm (p < 0.001), DH-Anterior was increased from 9.6 ± 2.3 mm to 13.4 ± 2.1 mm (p < 0.001), DH-Posterior was increased from 6.1 ± 1.9 mm to 9.1 ± 2.1 mm (p < 0.001), the slip ratio was reduced from 11.1 ± 4.6% to 8.3 ± 4.4% (p = 0.020) with the slip reduction ratio 25.6 ± 32.3%, and SL was slightly changed from 8.7 ± 3.7° to 8.3 ± 3.0°(p = 1.000). Following posterior fixation, the DH was unchanged (from 11.8 ± 1.7 mm to 11.8 ± 2.3 mm, p = 1.000), DH-Anterior and DH-Posterior were slightly changed from 13.4 ± 2.1 mm and 9.1 ± 2.1 mm to 13.7 ± 2.3 mm and 8.4 ± 1.8 mm respectively (P = 0.861, P = 0.254), the slip ratio was reduced from 8.3 ± 4.4% to 2.1 ± 3.6% (p < 0.001) with the slip reduction ratio 57.9 ± 43.9%, and the SL was increased from 8.3 ± 3.0° to 10.7 ± 3.6° (p = 0.008).ConclusionsCompared with stand-alone cage insertion, additional posterior fixation provides better segmental alignment improvement in terms of slip reduction and segmental lordosis in OLIF procedures in the treatment of lumbar degenerative spondylolisthesis.

Four Complications Associated with Lateral and Oblique Fusion Treatable with Endoscopic Spine Surgery: Technical Note and Case Series

Background The lateral fusion procedure is a newer minimally invasive approach to indirectly decompressing and fusing a lumbar motion segment. As with many new procedures, new thoughtful approaches to recognizing and treating the complications of these procedures need to be developed. Objectives Here we describe our experience with transforaminal endoscopic decompression for complications of lateral and oblique lumbar fusion. Study design Retrospective case review. Setting This was a multicenter study that took place in an academic hospital, community hospital, and ambulatory surgery center. Methods An endoscopic treatment technique for 4 types of complications associated with lateral and oblique fusion is presented. We retrospectively reviewed cases at 3 centers in 2 countries of patients who underwent transforaminal endoscopic surgery for the treatment of lateral fusion complications in a 4-year period with a minimum follow-up of 1 year. Results A preliminary series of 4 patients with an average age of 74.8 years (range, 69-82 years) who underwent transforaminal endoscopic procedures at the level of their lateral and oblique lumbar fusions between 2014 and 2018 is presented. Disc herniations, heterotopic bone formation, endplate fracture, and nerve root impingement by the interbody device were all treated endoscopically. Limitations Small case series evaluated retrospectively with 1-year follow-up. Conclusions Transforaminal endoscopic surgery is a useful minimally invasive surgical technique to treat several complications associated with lateral and oblique lumbar interbody fusion procedures.

Minimally invasive surgery for low-grade spondylolisthesis: percutaneous endoscopic or oblique lumbar interbody fusion.

Aim: To compare the clinical and radiographic outcomes of percutaneous endoscopic-assisted lumbar interbody fusion (PELIF) versus oblique lumbar interbody fusion (OLIF) for the treatment of symptomatic low-grade lumbar spondylolisthesis. Material & methods: The clinical and radiographic records of 48 patients underwent single-level minimally invasive lumbar fusion with a PELIF (n=16) or OLIF (n=32) were reviewed. Results: The clinical and radiographic outcomes were similar in both groups. PELIF procedure exhibited superior capability of the enlargement of foraminal width, but inferior capability of the restoration of foraminal height than OLIF procedure. Conclusion: PELIF minimizes the iatrogenic damages and perioperative risks to a great extent, and seems to be a promising option for the treatment of symptomatic low-grade lumbar spondylolisthesis.

Clinical Rehabilitation Effect of Postoperative Lower-Limb Training on the Patients Undergoing OLIF Surgery: A Retrospective Study.

Background In this study, it was aimed to investigate the clinical rehabilitation effect of lower-limb training on the patients that undergo oblique lumbar interbody fusion (OLIF) procedures. Methods The eligible participants undergoing OLIF procedures between 01/2017 and 07/2019 were identified. All the patients underwent one-segment fusion operation (L3-4 or L4-5). Based on whether the participants received postoperative rehabilitation training, they were divided into two groups: intervention group and control group. Postoperatively, the participants in the intervention group were trained with lower-extremity rehabilitation exercise and maintained for three months. All participants got reexamined at the first postoperative week, the second postoperative week, the first postoperative month, and the third postoperative month (last follow-up). Comparisons were made in terms of the lower-extremity muscle force, visual analogue scale (VAS) score, lumbar JOA score, Oswestry disability index (ODI), the incidence of deep venous thrombosis (DVT), and patient satisfaction. Results Seventy-seven participants in the intervention group (32 males and 45 females) and 82 in the control group (39 males and 43 females) were incorporated in this study. The median age of the participants was 57 years (39∼73) in the intervention group and 54 years (35∼71) in the control group. No statistical significance between the two groups was found (P > 0.05). ODI score was less in the intervention group as compared to the control group in the first week after surgery (P=0.029). VAS and JOA scores were better in the intervention group in the first two weeks after surgery (P < 0.05). DVT incidence in the intervention group was lower than the control group at final follow-up (P=0.037). Both group participants have achieved good grading in muscle force rehabilitation but no significant differences between the two groups. Additionally, satisfaction was higher in the intervention group than the control group. Conclusions In summary, postoperative lower-extremity rehabilitation exercise can effectively accelerate patients' health recovery from the OLIF surgery and increase their satisfaction.

295. Comparison of the biomechanical performances among PLF, TLIF, OLIF and XLIF: a finite element analysis

BACKGROUND CONTEXT Posterolateral fusion (PLF) and lumbar interbody fusion (LIF) are the commonly used techniques for the treatment of lumbar degenerative diseases. Although the superiority of PLF or LIF remains controversial, LIF technique provides the potential advantages of anterior column supports and 360° arthrodesis. The most commonly used LIF technique is transforaminal LIF (TLIF). Lateral approaches including extreme LIF (XLIF) and the subsequent oblique LIF (OLIF), have been accepted by an increasing number of spine surgeons due to their unique advantages. Previous studies revealed that radiological outcomes significantly varied among PLF, TLIF, XLIF and OLIF, suggesting their different biomechanical properties. PURPOSE To compare the biomechanical differences among PLF, TLIF, XLIF and OLIF construct and determine which surgical construct was most beneficialto the segmental stability and cage subsidence resistance. STUDY DESIGN/SETTING a finite element (FE) analysis. OUTCOME MEASURES The ranges of motion (ROMs) and stress peaks in the cortical endplate, cancellous bone and posterior instrumentations were compared among the five constructs. METHODS An intact FE model of the L3-L5 lumbar spine was constructed. After validation, the PLF, TLIF with a banana-shaped cage, TLIF with a straight cage, XLIF and OLIF procedures were simulated at the L4/5 level. A bilateral pedicle screw fixation was added in each construct. The TLIF banana-shaped cage was placed on the anterior one-third portion of the endplate. The TLIF straight cage was placed around the midpoint of the endplate and was diagonally positioned at an angle of 45° . The XLIF cage was placed at the mid-endplate and the OLIF cage was placed more anteriorly. An axial preload of 400 N was imposed on the superior surface of L3 to simulate the corresponding physiologic compression. Another 8 Nm was applied on L3 to simulate flexion, extension, bending and axial rotation. RESULTS The PLF construct has much higher ROMs than the LIF constructs (0.44° to -1.05° vs 0.29° to -0.72°). TLIF with a straight cage induces the highest stress peak in the endplate and cancellous bone (23.2-63.7 MPa and 0.69-2.03 MPa, respectively), followedby TLIF with a banana-shaped cage (23.7-44.8 MPa and 0.6-1.36 MPa, respectively). OLIF (16.76-32.41 MPa and 0.54-1.07 MPa, respectively) and XLIF (17.01-35.34 MPa and 0.56-1.12 MPa, respectively) constructs induces much lower stress peaks in the endplate and cancellous bone. In the PLF construct, the stress peaks in the posterior instrument range from 244.6 MPa to 377.4 MPa, which are significantly higher than those in the LIF constructs (123.9-237.4 MPa). CONCLUSIONS The PLF construct had\s less stability than the LIF construct due to the higher ROMs and stress peaks in the posterior instrument. TLIF with a banana-shaped cage outperforms TLIF with a straight cage in decreasing the stress peaks in the endplate and cancellous bone, as the banana-shaped cage is ideally located more anteriorly and placed on the strong cortical rim of the endplate. Compared with TLIF constructs, the much larger cages used in the OLIF and XLIF constructs induce significantly fewer stress peaks and increase homogeneous stress distributions in the endplate cancellous bone, which was beneficial to the subsidence resistance and maintenance of disc height and segmental angle. FDA DEVICE/DRUG STATUS XLIF (Approved for this indication), OLIF (Approved for this indication)

P87. Strategies for prevention of pseudarthrosis in adult spinal deformity: cobalt chrome rod, 4-rod fixation, and oblique lumbar interbody fusion with sacropelvic fixation

BACKGROUND CONTEXT Restoration of the sagittal alignment in adult spinal deformity (ASD) can produce excellent radiological and clinical outcomes, but pseudarthrosis is one of the most common complications with an incidence of 0% to 29%. Various surgical options are reported for reducing the incidence of pseudarthrosis, but these methods are controversial and have limitations. PURPOSE The purpose of this study was to identify the methods for reducing the incidence of pseudarthrosis in the surgical treatment of ASD. STUDY DESIGN/SETTING Retrospective, consecutive case review. PATIENT SAMPLE A total of 186 consecutive patients with degenerative lumbar kyphosis (average age 70.8 years) who underwent a long-segment fixation with a minimum 2-year follow-up. OUTCOME MEASURES Description and analysis of X-ray changes. METHODS Subjects were classified into the pseudarthrosis group (n=39) and the non-pseudarthrosis group (n=147). For predicting the factors of pseudarthrosis, patient factors, radiologic parameters, and surgical factors which include rod materials (Titanium vs Cobalt Chrome), the use of 4-rod fixation and sacropelvic fixation, correction methods (pedicle subtraction osteotomy vs oblique lumbar interbody fusion), and the history of the previous spine surgery were analyzed. RESULTS The overall pseudarthrosis rate was 21% (39/186). No significant differences in the incidence of pseudarthrosis regarding patient factors and preoperative radiological parameters were found between the two groups (p >0.05). Significant differences were observed in the postoperative sagittal vertical axis and thoracic kyphosis angle (p CONCLUSIONS Applications of cobalt chrome rod, 4-rod fixation, or oblique lumbar interbody fusion procedure with sacropelvic fixation will be promising methods for reducing pseudarthrosis in surgically treated ASD. FDA DEVICE/DRUG STATUS Unavailable from authors at time of publication.

Precautions for Combined Anterior and Posterior Long-Level Fusion for Adult Spinal Deformity: Perioperative Surgical Complications Related to the Anterior Procedure (Oblique Lumbar Interbody Fusion).

Study DesignRetrospective, single-center study.PurposeWe aimed to determine the perioperative complications of oblique lumbar interbody fusion (OLIF) as a first-stage procedure in combined anterior and posterior operation for adult spinal deformity (ASD) along with sagittal imbalance. Specifically, we aimed to identify the radiological and clinical types of perioperative surgical complications and the factors affecting these complications. Overview of LiteratureOLIF has recently gained popularity, and there are several reports of good outcomes and only a few of complications with OLIF; however, a few studies have focused on the perioperative surgical complications of ASD along with sagittal imbalance.MethodsThe perioperative period was a 1-week interval between the anterior and posterior procedures. All patients underwent simple radiography and magnetic resonance imaging preoperatively and postoperatively. Cage placement was evaluated for displacement (i.e., subsidence and migration) and vertebral body fracture. Clinical patient complaints were evaluated perioperatively. Student t-test was used for data analysis.ResultsA total of 46 patients were included, totaling 138 fusion segments. A week after OLIF, 14 patients/33 segments (30.4%/23.9%) demonstrated endplate injury-associated cage placement change. Subsidence was the most common cage placement-related complication. As compared with patients without endplate injury, those with endplate injuries showed significantly larger correction angles and a higher proportion of them had larger height cages than the disk height in the full-extension lateral view. Although 32.6% of the patients experienced perioperative clinical complications, they were relatively minor and transient. The most common complication was severe postoperative pain (Visual Analog Scale score of >7), and hip flexor weakness spontaneously resolved within 1 week.ConclusionsOLIF yielded more than expected endplate injuries from treatment modalities for ASD along with sagittal imbalance. Therefore, surgeons should be cautious about endplate injury during OLIF procedures. It is difficult to accomplish lordosis correction via OLIF alone; therefore, surgeons should not attempt this impractical correction goal and insert an immoderate cage.

Perioperative complications associated with minimally invasive surgery of oblique lumbar interbody fusions for degenerative lumbar diseases in 113 patients

ObjectivesTo describe perioperative complications occurring during oblique lumbar interbody fusion (OLIF) assisted by a retractor system for degenerative lumbar diseases. Patients and methodsThe perioperative complications in 113 cases series utilizing a minimally invasive approach were recorded and analyzed. One hundred thirteen patients who received OLIF for degenerative lumbar diseases between November 2014 and February 2017 at a single center were evaluated. The most frequent diagnosis was spondylolisthesis (59 cases, 52.2%), followed by lumbar instability (24 cases, 21.2%), adjacent segmental disease (12 cases, 10.6%), adult degenerative scoliosis (11 cases, 9.8%) and discogenic low back pain (7 cases, 6.2%). One hundred thirty-four levels were treated, 88.5% one-level, 4.4% two-level, and 7.1% three-level surgeries. The most fused level was L4-5 (94 levels, 70.2%), followed by L3-4 (31 levels, 23.1%), and L2-3 (9 levels, 6.7%). ResultsAll perioperative complications only included adverse events related to the OLIF procedure. The most observed complications were donor-site pain (24 cases, 21.2%), followed by vertebral endplate fracture (15 cases, 13.3%), thigh numbness/pain (12 cases, 10.6%), psoas/quadriceps weakness (5 cases, 4.4%), sympathetic nerve injury (2 case, 1.8%), paralytic ileus (one case, 0.9%), segmental artery injury (one case, 0.9%), intervertebral infection (one, 0.9%), and contralateral femoral nerve palsy (one, 0.9%). All complications, including postoperative ipsilateral or contralateral thigh paresthesia, pain, and psoas/quadriceps weakness, were observed when operating at L4-L5. The incidence of complications excluding donor-site pain was 24.8% (28/113 cases). The patients with donor-site pain, thigh numbness/pain, psoas/quadriceps weakness, sympathetic nerve injury and paralytic ileus recovered within two months following surgery. The patient with intervertebral infection recovered at 3 months after surgery. One case of contralateral femoral nerve palsy recovered completely with no residual sensory or motor deficit at 6 months. ConclusionsOLIF performed using a retractor system is a validated option to treat a wide spectrum of degenerative lumbar diseases with few perioperative complications and a quick recovery. Judicious use of this technique at the L4/5 level is recommended. Close attention to detail during the procedure can minimize complications that may be associated with the learning curve.

Vertebral Body Rotation in Patients with Lumbar Degenerative Scoliosis: Surgical Implication for Oblique Lumbar Interbody Fusion

To investigate changes of oblique corridor in patients with lumbar degenerative scoliosis and determine proper working angle with respect to the direction of vertebral axial rotation during the oblique lumbar interbody fusion procedure. The distance of oblique corridor and the rotational angle of the left or right apex group were measured on axial T2 magnetic resonance images and then compared with those of the propensity score-matched control group. Fifty-five patients of the left apex group and 57 patients of the right apex group were compared with the equal number of patients of the propensity score-matched control group. The distance of oblique corridor in the left apex group was shorter than that in the control group at the levels of L1-2 and L2-3. In contrast, the distance of oblique corridor in the right apex group was longer than that of the control group at the level of L2-3. Patients of the left apex group showed the vertebral body rotating to the left side from L1-2 to L5-S1, whereas in the right apex group, the vertebral body rotated to the right side at the levels of L1-2, L2-3, and L3-4. In the left apex group, the oblique corridor was decreased from psoas overlap, and coupled axial rotation to the left side might increase the risk of contralateral nerve root injury during orthogonally working. Thus, surgeons should pay attention to the state of coupled vertebral axial rotation of lumbar degenerative scoliosis for the oblique lumbar interbody fusion procedure.

Friday, September 28, 2018 1:00 PM–2:30 PM abstracts: achieving lumbar interbody fusion: 200. The oblique lumbar interbody fusion (OLIF), including the L5S1 level: early postoperative safety profile in a multicenter review

PURPOSE To demonstrate the safety of the OLIF including the L5-S1 level in the early postoperative period. STUDY DESIGN/SETTING Multicenter prospective dataThis is a multicenter study including eight centers performing the OLIF approach for primarily degenerative disorders of the lumbar spine. Patients agreed to data collection and IRB approvals were obtained. Patient reported outcomes (PRO), surgical information and complications were obtained for review. PATIENT SAMPLE A total of 50 subjects underwent a multilevel OLIF procedure that included L5-S1. None of the subjects had a primary diagnosis of lumbar deformity. There were 30 males and 20 females, the mean age was 63.6 years. There were ten single stage cases and 40 two-stage cases. There was an average of three levels per cases. OUTCOME MEASURES EBLVascular Injury Neurologic Injury Retrograde Ejaculation Ventral Hernia ODIEQ5D. RESULTS Overall mean EBL per case was 229.6cc., operative time per case was 200.4 minutes, mean hospital stay was 6.4 days There were 12 stand-alone constructs versus 38 OLIF with posterior instrumentation. Neuromonitoring was used in 40/50 stage 1 procedures, and 38/40 stage 2 procedures. Bone grafting included rhBMP-2 in 41 cases. Prior to discharge, there was one paresthesia and five weaknesses reported in six subjects, at 6 weeks, one of these events had resolved. There was one vascular injury, and two renal injuries. There were no reports of retrograde ejaculation, or ventral hernia. ODI (p CONCLUSIONS OLIF including the L5S1 level is a safe procedure and approach to the lumbar spine. OLIF for the L2L5 levels (O25) using the corridor anterior to the psoas, facilitates lateral interbody fixation with minimal to no risk to femoral and obturator nerve while obviating the postoperative muscle pain that occurs with complementary transpsoas procedures. OLIF for the L5S1 level (O51), is as safe and less invasive than the supine L5S1 ALIF approach and eliminates the requirement to flip the patient in these cases that require Lumbarfusion at L45 and L5S1. This is extremely beneficial considering that 60% of the lumbar lordosis is based in these two specific levels and the concomitant high incidence of discopathology which includes L4-S1. Although not statistically significant, injury to the Superior Hypogastric Plexus (SHP), the cause of retrograde ejaculation, was not found. There is the possibility if not the probability that by lessening the traction, displacement and retraction blade forces on the retroperitoneum during O51 compared the ALIF, that the SHP is at less risk a crush injury, vascular supply injury and traction injury. Incidence of ileus was low due to more minimally invasive retroperitoneal exposure compared to ALIF. Significant improvement noted in the Patient Reported Outcomes is expected considering OLIF mitigates psoas injury and major nerve injury by using the corridor anterior to the psoas for the approach. This as well as no major vessel mobilization nor ligation of the iliolumbar vein in O51 compared to ALIF results in at least equivalent safety profile for the inclusion of the L5S1 disk level, not previously possible with other lateral approaches to the lumbar spine.

Complications on minimally invasive oblique lumbar interbody fusion at L2-L5 levels: a review of the literature and surgical strategies.

Fusion is the cornerstone in the treatment of an unstable degenerative lumbar spinal disease. Various techniques have been developed. Amongst these techniques exists the oblique lumbar interbody fusion (OLIF), which is the ante-psoas approach. Adequate restoration of disc height with large cages placed in the intervertebral space, indirect decompression, and correction of sagittal and coronal alignment can be achieved with OLIF procedure with the advantage of minimal risk for the psoas muscle and lumbar plexus. Nevertheless, this technique entails complications directly associated with the anatomical location where the fusion takes place. This surgical area is a window between the left lateral border of the aorta, or the left common iliac artery, and the anterior belly of the left psoas muscle. Vascular complications associated with the injury of the main vessels, segmental artery or iliolumbar vein of the lumbar spine have been reported, as well as urologic lesions due to ureter transgression, amongst others. Although these complications have been described in the literature, an article that complements this information with technical advice for its avoidance is yet to be published. This article is a review of the most frequent complications associated with the OLIF procedure in L2-L5 lumbar levels, as well as a description of technical strategies for the prevention of such complications.