Oblique Lumbar Interbody Fusion: Technical Aspects, Operative Outcomes, and Complications

Li, Jia Xi Julian; Phan, Kevin; Mobbs, Ralph J.

doi:10.1016/j.wneu.2016.10.074

Cited by 159 publications

(132 citation statements)

References 31 publications

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“…Oblique lateral interbody fusion (OLIF) is a recently developed minimally invasive surgical technique for degenerative lumbar disorders. It offers several advantages, including less bleeding, achieving indirect decompression, restoring high disc height, and the ability to insert a huge cage, compared with its counterpart, transforaminal lumbar interbody fusion (TLIF). Pedicle screw fixation (PSF) is the most commonly used technique in spinal surgeries including OLIF procedures.…”

Section: Introductionmentioning

confidence: 99%

Robot‐assisted Percutaneous Transfacet Screw Fixation Supplementing Oblique Lateral Interbody Fusion Procedure: Accuracy and Safety Evaluation of This Novel Minimally Invasive Technique

Yuan

Liu

et al. 2019

Orthopaedic Surgery

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Objectives Percutaneous transfacet screw fixation (pTSF) is a minimally invasive posterior fixation technique supplementing oblique lateral interbody fusion (OLIF) for lumbar spinal disorders. Accurate screw insertion is difficult to achieve and technically demanding under 2‐D fluoroscopy. Recently developed robot‐assisted spinal surgery demonstrated a high level of accuracy of pedicle screw insertion and a low complication rate. No published study has reported this combination technique. The aim of our study was to evaluate the accuracy and safety properties of the combination of both minimally invasive techniques: robot‐assisted pTSF supplementing the OLIF procedure. Methods This was an experimental and prospective study. Selected consecutive patients with lumbar degenerative disorders received robot‐assisted pTSF supplementing the OLIF procedure using the TianJi Robot system operated by one senior surgeon from March to October 2018. The accuracy of screw insertion and perioperative screw‐related complications were evaluated. Assessment of the accuracy of screw insertion included intraoperative robotic guidance accuracy and incidence of screw encroachments. Intraoperative robotic guidance accuracy referred to translational and angular deviations of screws, which were assessed by comparing the planned and actual screw trajectories guided by the robot on reconstructed images using TianJi Robot Planning Software. Screw encroachments were evaluated on postoperative CT images and classified by a grading system (A, excellent; B, good; C, poor). Screw‐related complications including intraoperative pin skidding, screw malposition and adjustment, together with postoperative neurological symptoms that correlated with screw malposition were recorded. Results Ten patients, with an average age of 60.2 years, were selected and recruited in this study. All cases were degenerative lumbar spinal disorders, out of which there were 6 cases of Meyerding Grade I degenerative spondylolisthesis. Twenty‐four transfacet screws were inserted by robotic assistance. Instrumented levels included nine segments at L 4–5 level and three segments at L 3–4 level. Two patients had both L 4–5 and L 3–4 level fixation. The average surgical time was 3.3 h (SD, 0.8 h). The mean blood loss was 90 mL (SD, 32 mL). Intraoperative guidance accuracy showed 1.09 ± 0.17 mm (ranging from 0.75 to 1.22 mm) translational deviation and 2.17° ± 0.39° (ranging from 1.47° to 2.54°) angular deviation. The gradings of screw encroachment were: 17 screws (71%) with Grade A, 6 screws (25%) with Grade B, and 1 screw (4%) with Grade C. Only one pin skidding occurred intraoperatively and revised subsequently. No postoperative neurological complications were found. Conclusion Our preliminary study of robot‐assisted pTSF supplementing the OLIF procedure showed a hig...

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Section: Introductionmentioning

confidence: 99%

Robot‐assisted Percutaneous Transfacet Screw Fixation Supplementing Oblique Lateral Interbody Fusion Procedure: Accuracy and Safety Evaluation of This Novel Minimally Invasive Technique

Yuan

Liu

et al. 2019

Orthopaedic Surgery

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“…Less perioperative blood loss is also bene cial to patients, including reduced risk of exposure to pathogens, blood transfusion complication, perioperative anemia, morbidity, and mortality. In a recent systemic review on OLIF by Li et al, the 16 selected literatures showed a mean blood loss of 109.9 ml and an average surgery time of 95.2 minutes [13]. Another retrospective study on MIS-TLIF with 20 patients enrolled by Lee et al reported an average surgery time of 131.7 minutes and 208.3 ml blood loss [14].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Outcomes between Indirect Decompression of Oblique Lumbar Interbody Fusion and MIS-TLIF in One Single-level Lumbar Spondylosis: a case control study

Hung¹,

Liao²,

Tsai³

et al. 2020

Preprint

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Background Minimal invasive spinal fusion has become popular in the last decade. Oblique lumbar interbody fusion (OLIF) is a relatively new surgical technique and could avoid back muscle stripping and posterior complex destruction as in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Methods Between December 2016 and September 2018, patients with single level degenerative spondylosis were selected to enroll in this retrospective study. Results A total of 21 patients that underwent OLIF and 41 patients that received MIS-TLIF were enrolled. OLIF showed significantly less blood loss and shorter surgery time compared to MIS-TLIF (p < 0.05). The improvement in segmental lordosis and coronal balance was significantly more in OLIF group than MIS-TLIF group (p < 0.05). When comparing with MIS-TLIF, OLIF was significantly better in Oswestry Disability Index (ODI) and visual analogue scale for back pain improvement at post-operative 6 months (p < 0.05). Conclusions Both OLIF and MIS-TLIF are becoming a mainstream procedure for lumbar degenerative-related disease, especially for spondylolisthesis. However, OLIF has shown to have less perioperative blood loss and shorter surgery time than that of MIS-TLIF. In addition, OLIF gives superior clinical and radiographic outcomes. While both OLIF and MIS-TLIF provide optimal clinical outcomes, upon comparison between the two techniques, the anterolateral approach of OLIF seems to be a superior option in modern day.

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“…The technique has been described by Seex (2,11), Aghayev (9), and Kanno (10). The proposed advantages of the oblique approach allow for discectomy and cage insertion through the oblique corridor with lesser manipulation required of the major vessels and important anatomical structures (26,27). This corridor is bound by the psoas muscle laterally and aorta and inferior cava or common iliac vessels medially.…”

Section: Discussionmentioning

confidence: 99%

Morphometric anatomy of the lumbar sympathetic trunk with respect to the anterolateral approach to lumbar interbody fusion: a cadaver study

Rutter¹,

Phan²,

Smith³

et al. 2017

J. Spine Surg.

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Background: An approach to lateral lumbar interbody fusion (LLIF) utilizing an oblique corridor anterior to the psoas muscle was first described by Mayer in 1997 and subsequently by other authors. The only consistent structure of note in this corridor is the lumbar sympathetic trunk (LST), which at times must be mobilized in order to perform a discectomy and interbody fusion, thereby placing the LST at risk. This study was designed to describe the morphometric anatomy of the LST in relation to surgically relevant landmarks for the anterolateral approach to the lumbar spine at L3/L4 to L5/S1.Methods: Twenty-four embalmed cadavers (13 males, 11 females, age range, 50-89) were dissected to expose the LST. Bilateral measurements were recorded using a calliper under direct visualization, using the midsagittal plane of the lumbar spine as the reference landmark. The points were then marked with radioopaque needles, and 14 cadavers were scanned with CT to validate the measurements.Results: Of 48 LSTs, there was minimal difference in the direction of its course between sides; 14/24 specimens had concordant directions. The majority (n=28) had a medial to lateral cephalocaudal course. If osteophytes were present at the L4/L5 level, the majority of LSTs (n=7, of 8) were displaced lateral to the osteophyte. At the L5/S1 level, half of the cases with osteophytes (n=3, of 6) stretched the LST over the top of the osteophyte. The LST was adherent to the L4/L5 disc space bilaterally in 93% of cases.Conclusions: With the development of lumbar fusion techniques which utilize an oblique corridor and the retraction of psoas muscle, LST has become an important neural structure to define, protect and mobilize.In our morphometric analysis of 24 specimens, the position has been identified and quantified, and this paper notes variations, particularly distortions caused by degenerative processes. In this study, the LST ran in a medial to lateral direction from L3 to S1, and osteophytes typically displace and adhere to the LST.

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Oblique Lumbar Interbody Fusion: Technical Aspects, Operative Outcomes, and Complications

Cited by 159 publications

References 31 publications

Robot‐assisted Percutaneous Transfacet Screw Fixation Supplementing Oblique Lateral Interbody Fusion Procedure: Accuracy and Safety Evaluation of This Novel Minimally Invasive Technique

Robot‐assisted Percutaneous Transfacet Screw Fixation Supplementing Oblique Lateral Interbody Fusion Procedure: Accuracy and Safety Evaluation of This Novel Minimally Invasive Technique

Comparison of Outcomes between Indirect Decompression of Oblique Lumbar Interbody Fusion and MIS-TLIF in One Single-level Lumbar Spondylosis: a case control study

Morphometric anatomy of the lumbar sympathetic trunk with respect to the anterolateral approach to lumbar interbody fusion: a cadaver study

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