Oblique Lumbar Interbody Fusion with Selective Biportal Endoscopic Posterior Decompression for Multilevel Lumbar Degenerative Diseases

Abstract

Oblique lumbar interbody fusion is a minimally invasive procedure for treating degenerative lumbar disease. Its advantages include correcting coronal and sagittal spinal alignment and indirect neural decompression. However, achieving a successful outcome is limited in some patients who need direct decompression for central canal lesions including hard stenotic lesions (endplate or facet articular osteophytes and ossification of posterior longitudinal ligaments) and sequestration of the disk. Biportal endoscopic spinal surgery is a minimally invasive technique, which directly decompresses the lesion. By taking advantage of two procedures, in a longlevel lumbar lesion, alignment correction and direct decompression can be both achieved. Herein, the authors introduce multilevel lumbar fusion through oblique lumbar interbody fusion and selective direct decompression through biportal endoscopic spinal surgery and discuss the surgical indications, surgical pitfalls, and recommendations for application. Consequently, it is regarded as a minimally invasive interbody fusion method for patients with multilevel lumbar degenerative degeneration.

Osteobiologies for Spinal Fusion from Biological Mechanisms to Clinical Applications: A Narrative Review

“…There were advantages and disadvantages in the selection of bone grafts. One of the advantages of LIF (such as DLIF, OLIF, and ALIF) from the anterior or lateral approach is direct access to the intervertebral discs [60,61]. This access made complete disc removal possible and allowed for more efficient placement of the bone graft substitutes with largesized cages [61,62].…”

“…One of the advantages of LIF (such as DLIF, OLIF, and ALIF) from the anterior or lateral approach is direct access to the intervertebral discs [60,61]. This access made complete disc removal possible and allowed for more efficient placement of the bone graft substitutes with largesized cages [61,62]. However, in the case of expected insufficient bone fusion, such as the use of the current DBM and allograft only, it is essential to posterior instrumentation to maintain spine stability [63].…”

Expandable Cages for Lumbar Interbody Fusion: A Narrative Review

“…Subsequently, transforaminal lumbar interbody fusion (TLIF), which provides access through the space between the nerve roots and dura mater via a posterior approach, was developed and is widely used [19]. Furthermore, minimally invasive approaches from the anterior and lateral corridors have gained popularity, including procedures such as oblique lumbar interbody fusion (OLIF) and direct lateral interbody fusion (DLIF), which are frequently performed [17,20]. These advancements in surgical techniques are aimed at minimizing tissue disruption and reducing the overall invasiveness of spinal procedures [21,22].…”