Transfacet Oblique Lateral Lumbar Interbody Fusion: Technical Description and Early Results

Abstract

The oblique lateral lumbar interbody fusion (OLLIF) is a relatively new method of lumbar interbody fusion (LIF) that utilizes a trans-Kambin approach to the disc space. The OLLIF can be performed from T12-S1 in the majority of cases but is occasionally obstructed at the L5-S1 level by osteophytes, an overgrown facet joint and/or prominent sacral ala. Transfacet OLLIF (TF-OLLIF) is a novel method for LIF in which the disc space is accessed by drilling through hypertrophic facets with an OLLIF approach. We provide a proof-ofconcept report on the TF-OLLIF surgical technique and report the clinical and perioperative outcomes for the first 29 patients who underwent this procedure. MethodsThis is a retrospective single surgeon cohort study of 29 patients with lumbar spinal stenosis (LSS) who underwent TF-OLLIF procedures between 8/2018 and 1/2021. The primary outcome was a change in the Oswestry Disability Index (ODI) one year after surgery. Secondary outcomes were surgery time, blood loss, hospital stay, and complications. The TF-OLLIF was performed using the approach and instrumentation of OLLIF. When osseous hypertrophy is reached during the approach, an 8 mm drill is used to drill through the obstructing bone with continuous neuromonitoring. Discectomy and interbody placement are performed with subsequent posterior pedicle screw fixation. ResultsODI improved from 49% pre-op to 31% at one-year follow-up. Estimated blood loss ranged from 97.6±93.3 ml for one level TF-OLLIF to 146.2±60.3 ml for a 3+ level TF-OLLIF. Operative time ranged from 57.4±19.5 minutes for a one-level TF-OLLIF to 102.9±27.8 minutes for a 3+ level TF-OLLIF. The average length of hospital stay (LOS) was 0.4±0.8 days for one-level TF-OLLIF and 1.6±1.9 days for 3+ level TF-OLLIF. Complications included five cases of nerve root irritation immediately postoperatively, with three of these patients still reporting mild L5 distribution numbness at the last follow-up, which was not clinically limiting. ConclusionThe first 29 cases of TF-OLLIF demonstrated that it is a safe method of interbody fusion that yields good clinical results. This is an important development for practitioners of OLLIF as it enables interbody placement with OLLIF instruments and approach even for challenging L5-S1 levels without compromising surgical outcomes.

Using Novel Segmentation Technology to Define Safe Corridors for Minimally Invasive Posterior Lumbar Interbody Fusion

“…38 It has also been reported that making 3 or more attempted passes through the Kambin triangle during a TLIF can increase the rate of nerve root irritation. 39 For this reason, the transfacet approach was introduced as an alternative option for patients who require larger cage dimensions or have anatomy which makes accessing the disk space through the other pathways more risky. First described by Khalifeh et al, 23 the proposed transfacet approach was a modification to the standard minimally invasive TLIF for the treatment of lumbar degenerative diseases and low-grade spondylolisthesis.…”

Using Augmented Reality Technology to Optimize Transfacet Lumbar Interbody Fusion: A Case Report

“…Even though multiple studies have demonstrated the necessity of pre-operatively measuring these corridors in order to define the safest trajectory for each patient’s specific spinal anatomy, a surgeon must also be prepared to alter their operative course if those corridors will not provide enough room for a successful interbody fusion [ 12 , 13 ]. For that reason, other minimally invasive approaches, such as the relatively novel transfacet approach, have begun to gain popularity as alternatives routes to the disc space since they provide better working areas for endplate preparation and larger cage dimensions [ 14 , 15 ]. Having said this, it is difficult to compare the relative areas and trajectories of each approach from only examining pre-operative 2D images like CT and MRI alone.…”