The OLIF working corridor based on magnetic resonance imaging: a retrospective research

Abstract

Objective: To provide an anatomical basis for the development of oblique lumbar interbody fusion (OLIF) in Chinese patients. Methods: Between November 2018 and June 2019, 300 patients' lumbar MRI data were reviewed. According to the Moro system and zone method described by us, the axial view was vertically divided into 6 zones (A, I II, III, IV, P) and was horizontally divided into 4 zones (R, a, b, c, L). The locations of left psoas muscle and the major artery at L2/3, L3/4, and L4/5 levels were evaluated by the grid system. The aortic bifurcation segments will also be evaluated at the level of the vertebral body or the disc. Results: At the L2/3 level, left psoas muscle and the major artery in zone Ib were found in 28.0% of subjects, in zone IIb in 20.3%, and in zone Ic in 20.0%; at the L3/4 level, in zone Ab in 20.7% of subjects, in zone Ac in 26.0%, and in zone Ic in 11.0%; and at the L4/5 level, areas in zone Ab in 31.0% of subjects, in zone Ac in 26.0%, and in zone Ib in 11.7%. The aortic bifurcation segments were mainly at the L4 level. The zone of the left psoas muscle at all levels, the zone of the major artery at L4/5 level, and the zone of the aortic bifurcation segments had significant correlation with gender difference (P < 0.05). Conclusion: The left-sided OLIF at L2-L5 disc levels can be a feasible type of surgery for lumbar interbody fusion in the majority of Chinese patients. Before the operation, in order to screen out the appropriate surgical approach, routine lumbar magnetic resonance imaging is recommended to analyze the patient's local anatomical features.

Comparison of outcomes between indirect decompression of oblique lumbar interbody fusion and MIS-TLIF in one single-level lumbar spondylosis

“…Then, a surgical incision of 4–6 cm and 3–5 cm ventral to the anterior vertebral cortex of the target intervertebral disc was made. We used blunt dissection of abdominal external oblique, internal oblique, and transversalis muscles to approach the retroperitoneal space and the disc space in the oblique corridor (the space between the major blood vessel and the psoas muscle) 14 . After the target disc space was identified, sequential soft tissue dilators and blade retractor were applied to establish the retroperitoneal pathway to the oblique corridor under direct visualization.…”

The Antepsoas (ATP) Surgical Corridor for Lumbar and Lumbosacral Arthrodesis: A Radiographic, Anatomic, and Surgical Investigation

“…Consequently, the authors highlighted certain anatomic relationships of psoas-vessels at L4–L5 being nonconducive for a safe of OLIF technique (Figure 7). 15,16 Contrastingly, we found that a left-sided ATP approach provided an average operative window of 36 mm consistently allowing for safe surgery (n=4 AL zone patients. Figure 7).…”

Oblique Lateral Lumbar Interbody Fusion at L2-L5: Proposal of a New CT-based Preoperative Assessment to Minimize Risks

“…To make the procedure as safe as possible, several image-based and cadaveric dissection studies have intensively examined the surgical ATP corridor [7][8][9][10][11][12][13][14][15][16][17]. Most of these publications are based on Asian [8][9][10][11][12][13][14]16] and American [7,15,17] populations.…”

“…Variations in the location of these structures can obstruct or modify the surgical corridor to reach the disc, thereby increasing the risk of fatal intraoperative vascular complications [8]. Therefore, anatomical research based on different imaging modalities and cadaveric studies has detailed the features of the left-sided ATP oblique corridor and the surrounding spinal retroperitoneal structures [7][8][9][10][11][12][13][14][15][16][17].…”