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

Abstract

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.

The Navigated Oblique Lumbar Interbody Fusion: Accuracy Rate, Effect on Surgical Time, and Complications

“…According to previously published reports on OLIF, transient neurological symptoms were reported to range from 6.1% to 21.4%, the incidence of left abdominal incisional pain was 2.2%, the rate of psoas hematomas were 1.4% to 4.8%, the ileus rates were 2.1% to 9.8%, and vascular injury rates were 1.6% to 2.9%. [16][17][18] In our series, the rate of transient neurological symptoms was 10.28%, which were defined as neurological symptoms that resolved within 30 days after surgery 16 ; the rate of left abdominal incisional pain was 0.93%, ileus was 1.4%, and none for vascular injury. Other complications in our series occurred with comparable rates of other reports, with a rate of 0.41% of psoas abscess, a rate of 0.93% for DVTs, and a 0.93% rate of urinary retention.…”

Biomechanical comparison of stand-alone and bilateral pedicle screws fixation for oblique lumbar inter-body fusion surgery – a finite element analysis

“…OLIF surgery has become popular recent years. Stand-alone procedure offer patients many benefits small incision and scar, less blood loss, less pain, less hospitalization time, faster recovery [1][2][3][4][5].…”

“…Nevertheless, the complications fluctuate from 3.7%to 66.7% [1][2][3][4][5][13][14]. Shun-wu Fan reviewed 235 patients with OLIF surgery and found 22 cases of endplate damage.…”

“…The stand-alone procedure brings low risk of posttreatment trauma or bleeding and offers good stability and quick recovery. However, the complications associated with this technique have been reported frequently [2][3][4][5]. Abe reported 155 patients with OLIF surgery, 75 complications were reported (incidence rate, 48.3%).…”

Outcomes of Minimally Invasive Oblique Lumbar Interbody Fusion in Patients with Lumbar Degenerative Disease with Rheumatoid Arthritis

“…After changing the patient's position to prone, additional pedicle screws were fixed using a percutaneous technique. Further details of the MI-OLIF procedure, including cage trajectories and procedure-related complications, were described by Quillo-Olvera et al 16 One patient (patient 8) required a direct posterior decompression by L4-L5 decompressive laminotomy and L5-S1 left hemilaminotomy with diskectomy. This patient presented with a preoperative neurologic deficit of left-side L3, L4, and L5 nerve roots (Medical Research Council [MRC] grade III/V) and required a laminotomy because the migrated disk fragment could not be accessed from anterior.…”