Complications and Morbidities of Mini-open Anterior Retroperitoneal Lumbar Interbody Fusion: Oblique Lumbar Interbody Fusion in 179 Patients

Abstract

Study DesignA retrospective study including 179 patients who underwent oblique lumbar interbody fusion (OLIF) at one institution.PurposeTo report the complications associated with a minimally invasive technique of a retroperitoneal anterolateral approach to the lumbar spine.Overview of LiteratureDifferent approaches to the lumbar spine have been proposed, but they are associated with an increased risk of complications and a longer operation.MethodsA total of 179 patients with previous posterior instrumented fusion undergoing OLIF were included. The technique is described in terms of: the number of levels fused, operative time and blood loss. Persurgical and postsurgical complications were noted.ResultsPatients were age 54.1 ± 10.6 with a BMI of 24.8 ± 4.1 kg/m2. The procedure was performed in the lumbar spine at L1-L2 in 4, L2-L3 in 54, L3-L4 in 120, L4-L5 in 134, and L5-S1 in 6 patients. It was done at 1 level in 56, 2 levels in 107, and 3 levels in 16 patients. Surgery time and blood loss were, respectively, 32.5 ± 13.2 minutes and 57 ± 131 ml per level fused. There were 19 patients with a single complication and one with two complications, including two patients with postoperative radiculopathy after L3-5 OLIF. There was no abdominal weakness or herniation.ConclusionsMinimally invasive OLIF can be performed easily and safely in the lumbar spine from L2 to L5, and at L1-2 for selected cases. Up to 3 levels can be addressed through a 'sliding window'. It is associated with minimal blood loss and short operations, and with decreased risk of abdominal wall weakness or herniation.

The Oblique Anterolateral Approach to the Lumbar Spine Provides Access to the Lumbar Spine With Few Early Complications

“…Using the natural ''safety'' corridor between the anterior longitudinal ligament as a medial landmark and the psoas muscle as a lateral landmark, the target area is covered by only the fibers of the sympathetic chain. The low percentage of lumbar plexus injuries in our patients is in line with reported percentages using the oblique lumbar interbody fusion technique (four of 179 patients, two with persisting [44] or no irritation [1,24]). Conversely, the risks of neurologic complications were less frequent in anterior lumbar interbody fusion procedures.…”

“…Our overall infection risk of 0.62% is comparable to those reported for the midline or extreme lateral access routes of 0% to 6% [5,12,15,24,32,34,[39][40][41]. With respect to previous studies on the oblique psoas-sparing approach, in the largest series of 179 patients, Silvestre et al [44] did not report on the general risk of infection and hematoma. Ohtori et al [36,37] used the oblique psoas-sparing approach for varying indications and only for small patient cohorts (12 and 35 patients) without reporting on either infection or hematoma.…”

“…Mayer [28] did not report any vascular complications in his initial delineation of the oblique lumbar interbody fusion technique. Using an identical oblique lumbar interbody fusion technique, Silvestre et al [44] reported a vascular complication risk of 1.68% including iliac and iliolumbar venous lacerations. These results are comparable to those for far lateral approaches such as the extreme lateral transpsoas approach, which were developed specifically to avoid vascular injury, and which range from 0% to 0.11% in large case series [22,40].…”

“…However, studies on intra-and perioperative complications of the oblique psoassparing approach have been based on small cohorts of patients undergoing surgery for different indications [36,37,42]. Silvestre et al [44] reported the results of 179 patients who underwent oblique lumbar interbody fusion, but a single-center series focusing on inpatient complications has not been reported to our knowledge.…”

Evaluation of the location of intervertebral cages during oblique lateral interbody fusion surgery to achieve sagittal correction

“…These procedures are attracting more attention since they are less invasive. Two popular and common LLIF procedures are oblique lateral interbody fusion (OLIF) and extreme lateral interbody fusion (XLIF), which each require specially designed instruments [12][13][14][15] . OLIF, especially, enables surgeons to easily and less invasively access the vacant oblique corridor in front of the psoas muscles without causing any splitting, which occurs with XLIF 16,17) .…”