[Lumbar fusion-Indications and techniques].
Schnake K J,Rappert D,Storzer B,Schreyer S,Hilber F,Mehren C
Der Orthopade
BACKGROUND:Lumbar spinal fusion is an established surgical technique in spine surgery. The goal of spinal fusion is a biomechanically lasting interbody union, which can be accomplished through different surgical approaches, implants and grafts. TECHNIQUES:The mainly surgical techniques used are: posterior lumbar fusion (PLF), posterior interbody lumbar fusion (PLIF), transforaminal lumbar interbody fusion (TLIF), anterior lumbar interbody fusion (ALIF), oblique lumbar interbody fusion (OLIF) and extreme lateral interbody fusion (XLIF). These procedures, their indications, complications and results are described in this narrative review.
10.1007/s00132-018-03670-w
Insidious intraoperative ureteral injury as a complication in oblique lumbar interbody fusion surgery: a case report.
Kubota Go,Orita Sumihisa,Umimura Tomotaka,Takahashi Kazuhisa,Ohtori Seiji
BMC research notes
BACKGROUND:Oblique lumbar interbody fusion surgery is a recently introduced minimally invasive lateral interbody fusion surgery for degenerative lumbar disease. There have been no reports of associated ureteral injury. CASE PRESENTATION:A 77-year-old Japanese woman underwent oblique lumbar interbody fusion surgery for lumbar spondylolisthesis with refractory low back pain and pain in both legs. The patient experienced abdominal pain 2 days after surgery. Delayed contrast-enhanced computed tomography and retrograde urography revealed leakage of contrasted urine from the ureter into the retroperitoneal space, indicating a ureteral injury. Immediate percutaneous nephrostomy was performed to recover her condition, followed by additional ureteral stenting. She is now free from preoperative symptoms but requires periodic changing of the ureteral stent, with no urinary symptoms. CONCLUSION:The current report described a rare but possible case of ureteral injury following oblique lumbar interbody fusion surgery. Iatrogenic ureteral injury, as reported in the current case, is uncommon following oblique lumbar interbody fusion surgery, and the injury may have been caused by a procedural error. Considering the findings from urological examinations, we speculate that the thread pin that fixates the retractor injured the ureter during its installation. This case highlights the importance of careful attention while exposing the retroperitoneal space to avoid minor organs, including the ureters, as well as major organs. Ureteral injuries should ideally be detected and diagnosed as soon as possible by careful physical and radiological examinations, such as with delayed contrast-enhanced computed tomography and retrograde urography, to salvage the injured nephroureteral system. The current report also highlights that careful use of surgical instruments is key for preventing intraoperative complications, including ureteral injury.
10.1186/s13104-017-2509-9
Oblique Lumbar Interbody Fusion for Revision of Non-union Following Prior Posterior Surgery: A Case Report.
Phan Kevin,Mobbs Ralph J
Orthopaedic surgery
We report the case of a 75-year-old lady who presented with a L2-3 non-union 18 months following a L2-3 and L3-4 posterior decompression and transforaminal lumbar interbody fusion. Halo of the L2 pedicle screws on imaging was consistent with a non-union at the L2-3 level. An anterior lumbar interbody fusion (ALIF) approach was originally considered. However, due to the high lumbar approach and patient habitus [body mass index (BMI) > 35], a decision was made to approach the L2-3 level using an oblique technique. This involved dissection anterior to the psoas muscle to access the L2-3 disc space. The psoas, kidney and retroperitoneum were retracted using a Synframe for the oblique trajectory. Removal of the prior trans-foraminal lumbar interbody fusion cage was performed via the oblique approach and insertion of a revised implant. The operation was completed successfully with no perioperative complications noted. Length of stay was 3 days, with the patient achieving rapid pain relief. In the present report, we report the first case using an oblique lumbar interbody fusion (OLIF) approach for revision of a prior posterior fusion non-union at the L2,3 level. The OLIF technique is feasible for revision of a non-union of upper lumbar levels, with satisfactory fusion achieved with acceptable feasibility.
10.1111/os.12204
Complications for minimally invasive lateral interbody arthrodesis: a systematic review and meta-analysis comparing prepsoas and transpsoas approaches.
Journal of neurosurgery. Spine
OBJECTIVEMinimally invasive anterolateral retroperitoneal approaches for lumbar interbody arthrodesis have distinct advantages attractive to spine surgeons. Prepsoas or transpsoas trajectories can be employed with differing complication profiles because of the inherent anatomical differences encountered in each approach. The evidence comparing them remains limited because of poor quality data. Here, the authors sought to systematically review the available literature and perform a meta-analysis comparing the two techniques.METHODSA systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A database search was used to identify eligible studies. Prepsoas and transpsoas studies were compiled, and each study was assessed for inclusion criteria. Complication rates were recorded and compared between approach groups. Studies incorporating an analysis of postoperative subsidence and pseudarthrosis rates were also assessed and compared.RESULTSFor the prepsoas studies, 20 studies for the complications analysis and 8 studies for the pseudarthrosis outcomes analysis were included. For the transpsoas studies, 39 studies for the complications analysis and 19 studies for the pseudarthrosis outcomes analysis were included. For the complications analysis, 1874 patients treated via the prepsoas approach and 4607 treated with the transpsoas approach were included. In the transpsoas group, there was a higher rate of transient sensory symptoms (21.7% vs 8.7%, p = 0.002), transient hip flexor weakness (19.7% vs 5.7%, p < 0.001), and permanent neurological weakness (2.8% vs 1.0%, p = 0.005). A higher rate of sympathetic nerve injury was seen in the prepsoas group (5.4% vs 0.0%, p = 0.03). Of the nonneurological complications, major vascular injury was significantly higher in the prepsoas approach (1.8% vs 0.4%, p = 0.01). There was no difference in urological or peritoneal/bowel injury, postoperative ileus, or hematomas (all p > 0.05). A higher infection rate was noted for the transpsoas group (3.1% vs 1.1%, p = 0.01). With regard to postoperative fusion outcomes, similar rates of subsidence (12.2% prepsoas vs 13.8% transpsoas, p = 0.78) and pseudarthrosis (9.9% vs 7.5%, respectively, p = 0.57) were seen between the groups at the last follow-up.CONCLUSIONSComplication rates vary for the prepsoas and transpsoas approaches owing to the variable retroperitoneal anatomy encountered during surgical dissection. While the risks of a lasting motor deficit and transient sensory disturbances are higher for the transpsoas approach, there is a reciprocal reduction in the risks of major vascular injury and sympathetic nerve injury. These results can facilitate informed decision-making and tailored surgical planning regarding the choice of minimally invasive anterolateral access to the spine.
10.3171/2018.9.SPINE18800
Lateral Lumbar Interbody Fusion.
Taba Houtan A,Williams Seth K
Neurosurgery clinics of North America
Lateral lumbar interbody fusion (LLIF) is a minimally invasive technique that allows access to the lumbar spine from L1/2 to L4/5 for placement of wide interbody devices. This technique is used in the treatment of degenerative conditions, deformity, and infectious, neoplastic, and traumatic thoracolumbar pathology. LLIF allows placement of interbody devices across the apophysis, which leads to powerful coronal deformity correction and indirect decompression from restoration of disk height. Literature shows equivalent to superior outcomes of the LLIF technique to anterior or posterior techniques in the treatment of degenerative conditions while avoiding the complications associated with larger procedures.
10.1016/j.nec.2019.08.004
Spondylolisthesis with Uncommon Congenital Deformity of L4-L5 Vertebral Fusion Treated by Oblique Lumbar Interbody Fusion.
Cheng Cheng,Wang Kai,Zhang Can,Wu Hao,Jian Feng-Zeng
World neurosurgery
BACKGROUND:Diagnosis and management of congenital anomalies of the spine can be a challenge because of their complex presentations. We present an uncommon case of congenital deformity of the spine with L4-L5 vertebral fusion, mimicking a single vertebra, and L3 spondylolisthesis treated by oblique lumbar interbody fusion (OLIF). CASE DESCRIPTION:A 69-year-old woman presented with increasing lower back pain radiating to the left leg, with aggravation of symptoms for the past 6 months, causing difficulty in walking. She also complained of paresthesia along the L3-L5 dermatomes in both legs, with more prominence on the left side. Imaging revealed fusion deformity of the L4-L5 vertebrae, as well as degenerative spondylolisthesis at the L3-L4 level. After treatment with OLIF, the patient had an uneventful recovery period. Comparisons were made between the preoperative and 6-month follow-up visual analog scale and the Oswestry Disability Index scores. The patient showed significant improvement in the scores, as well as in her symptoms. CONCLUSIONS:OLIF is a promising technique that can be applied in the management of degenerative disk diseases and also for deformities that may be formidable to treat by adopting the traditional posterior approach.
10.1016/j.wneu.2019.04.021
Complications on minimally invasive oblique lumbar interbody fusion at L2-L5 levels: a review of the literature and surgical strategies.
Quillo-Olvera Javier,Lin Guang-Xun,Jo Hyun-Jin,Kim Jin-Sung
Annals of translational medicine
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.
10.21037/atm.2018.01.22
Lateral and Oblique Lumbar Interbody Fusion-Current Concepts and a Review of Recent Literature.
Current reviews in musculoskeletal medicine
PURPOSE:To review the relevant recent literature regarding minimally invasive, lateral, and oblique approaches to the anterior lumbar spine, with a particular focus on the operative and postoperative complications. METHODS:A literature search was performed on Pubmed and Web of Science using combinations of the following keywords and their acronyms: lateral lumbar interbody fusion (LLIF), oblique lateral interbody fusion (OLIF), anterior-to-psoas approach (ATP), direct lateral interbody fusion (DLIF), extreme lateral interbody fusion (XLIF), and minimally invasive surgery (MIS). All results from January 2016 through January 2019 were evaluated and all studies evaluating complications and/or outcomes were included in the review. RECENT FINDINGS:Transient neurological deficit, particularly sensorimotor symptoms of the ipsilateral thigh, remains the most common complication seen in LLIF. Best available current literature demonstrates that approximately 30-40% of patients have postoperative deficits, primarily of the proximal leg. Permanent symptoms are less common, affecting 4-5% of cases. Newer techniques to reduce this rate include different retractors, direct visualization of the nerves, and intraoperative neuromonitoring. OLIF may have lower deficit rates, but the available literature is limited. Subsidence rates in both LLIF and OLIF are comparable to ALIF (anterior lumbar interbody fusion), but further study is required. Supplemental posterior fixation is an active area of investigation that shows favorable biomechanical results, but additional clinical studies are needed. Minimally invasive lumbar interbody fusion techniques continue to advance rapidly. As these techniques continue to mature, evidence-based risk-stratification systems are required to better guide both the patient and clinician in the joint decision-making process for the optimal surgical approach.
10.1007/s12178-019-09562-6
Use of an Alternative Surgical Corridor in Oblique Lateral Interbody Fusion at the L5-S1 Segment: A Technical Report.
Chung Nam-Su,Jeon Chang-Hoon,Lee Han-Dong
Clinical spine surgery
STUDY DESIGN:Technical report. OBJECTIVE:To demonstrate the use of an alternative surgical corridor in oblique lateral interbody fusion (OLIF) at the L5-S1 segment. SUMMARY OF BACKGROUND DATA:OLIF L5-S1 is essentially performed through the central disk space between the bifurcations of the iliac vessels, which is sometimes difficult due to the vascular structures that obstruct the surgical field. Another concern is retrograde ejaculation following superior hypogastric plexus injury in male patients. MATERIALS AND METHODS:The alternative surgical corridor involves the lateral disk space external to the left iliac vessels. The patient position and the retroperitoneal approach are similar to those used in the conventional OLIF L5-S1. The left iliac vessels are identified and mobilized medially to the midline of the L5-S1 disk space. The vascular structures are then protected using the conventional OLIF 51 retractor system. RESULTS:Six patients underwent OLIF L5-S1 through the alternative lateral surgical corridor. The L5-S1 disk spaces were always exposed sufficiently for disk preparation and cage insertion. The postoperative radiographs showed a satisfactory L5-S1 reconstruction with good cage position. There were no perioperative complications during the surgical access and reconstruction procedures. CONCLUSIONS:When the central approach to the L5-S1 disk space poses a risk of vascular or superior hypogastric plexus injury, use of a lateral approach external to the left iliac vessels can be an alternative method to perform OLIF L5-S1.
10.1097/BSD.0000000000000584
Development and Application of Oblique Lumbar Interbody Fusion.
Li Renjie,Li Xuefeng,Zhou Hong,Jiang Weimin
Orthopaedic surgery
The present study reviewed the relevant recent literature regarding the development and application of oblique lumbar interbody fusion (OLIF), with a particular focus on its application and associated complications. The study evaluated the rationality of this technique and demonstrated the direction of future research by collecting data on previous operative outcomes and complications. A literature search was performed in Pubmed and Web of Science, including the following keywords and abbreviations: anterior lumbar interbody fusion (ALIF), lateral lumbar interbody fusion (LLIF), direct lateral interbody fusion (DLIF), extreme lateral interbody fusion (XLIF), oblique lateral interbody fusion (OLIF), adjacent segment disease (ASD), and adult degenerative scoliosis (ADS). A search of literature published from January 2005 to January 2019 was conducted and all studies evaluating development and application of OLIF were included in the review. According to the literature, the indications for OLIF are various. OLIF has excellent orthopaedic effects in degenerative scoliosis patients and the incidence of bony fusion is higher than for other approaches. It also provides a better choice for revision surgery. It has various advantages in many aspects, but the complications cannot be ignored. As a new minimally invasive technique, the advantages of OLIF are obvious, but further evaluation is needed to compare its operation-related data with that of traditional open surgery. In addition, more prospective studies are required to compare minimally invasive and open spinal surgery to confirm its specific efficacy, risk, advantages, learning curve, and ultimate clinical efficacy.
10.1111/os.12625
Oblique Lateral Interbody Fusion (OLIF) with Supplemental Anterolateral Screw and Rod Instrumentation: A Preliminary Clinical Study.
Liu Jinping,Feng Hailong
World neurosurgery
OBJECTIVE:This study aimed to evaluate the technical details, clinical effectiveness, and complications of oblique lateral interbody fusion supplemented with anterolateral screw-rod instrumentation in managing degenerative lumbar diseases. METHODS:The clinical data of 14 patients with lumbar degenerative diseases who underwent oblique lateral interbody fusion and anterolateral screw-rod instrumentation in the Department of Neurosurgery, Sichuan Provincial People's Hospital, from April 2015 to May 2018, were retrospectively analyzed. The duration of operation, estimated blood loss, radiological exposure, length of hospital stay, and complications were recorded. The visual analog scale score, Oswestry Disability Index, and radiologic parameters were evaluated before and after surgery. RESULTS:The diagnosis included degenerative/isthmic spondylolisthesis (grade I), degenerative lumbar stenosis, disc hernia with instability, and adjacent segment disease. The follow-up period was 12-45 months. The clinical symptoms improved significantly after the operation according to the visual analog scale and Oswestry Disability Index scores. The average operation time, blood loss, and length of hospital stay were 72.50 ± 21.46 minutes, 53.21 ± 19.07 mL, and 5.57 ± 2.21 days, respectively. The postoperative radiographic examination demonstrated increased intervertebral height and foramen area (P < 0.05). The radiologic fusion rate was 95% at the last follow-up; cage subsidence was found in 1 case. No major complications, such as vascular injury, ureteral injury, or infection, occurred. CONCLUSIONS:As an alternative method of instrumentation, anterolateral screw-rod fixation minimized the total operation time, blood loss, radiological exposure, and soft tissue disruption, and realized 1-stage intervertebral fusion and instrumentation through a single small incision.
10.1016/j.wneu.2019.11.046
Anterior lumbar fusion techniques: ALIF, OLIF, DLIF, LLIF, IXLIF.
Allain Jérôme,Dufour Thierry
Orthopaedics & traumatology, surgery & research : OTSR
An anterior approach to the lumbar spine is increasingly used in performing fusion. Depending on the level to be treated, several approaches have been developed to deal with the anatomic obstacles encountered: pure anterior, oblique anterior or lateral, and trans- or pre-psoas. Conventional techniques incur risk of muscle lesion and severe bleeding, and have been replaced by minimally invasive approaches, often with video assistance after rapid closure of laparoscopic approaches with gas insufflation. There has, in parallel, been great progress in anterior spinal instrumentation systems. Non-existent when these techniques were first developed, they have become increasingly sophisticated, and now employ a variety of stand-alone or not cages and anterior screwed plate that can be associated together or to posterior fixation. Each approach and type of fixation has its specific technical requirements that need to be fully mastered so as to minimize risk, especially regarding vessels, and to enable the patient to enjoy the benefit of their very low morbidity. We shall therefore detail here each step of the pure anterior approach, which is most often used for L5S1, the oblique and lateral approaches, mainly used for L2L5, and also the preparation of the lumbar spine for anterior interbody fusion, with the respective instrumentations. We shall then consider the pros, cons and risks, and also spinal or general contraindications that may sometimes preclude this option. From this, we shall derive the specific optimal and wrong indications for anterior lumbar surgery, to help decision-making when fusion is indicated.
10.1016/j.otsr.2019.05.024
Review of early clinical results and complications associated with oblique lumbar interbody fusion (OLIF).
Phan Kevin,Maharaj Monish,Assem Yusuf,Mobbs Ralph J
Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
Lumbar interbody fusion represents an effective surgical intervention for patients with lumbar degenerative diseases, spondylolisthesis, disc herniation, pseudoarthrosis and spinal deformities. Traditionally, conventional open anterior lumbar interbody fusion and posterior/transforaminal lumbar interbody fusion techniques have been employed with excellent results, but each with their own advantages and caveats. Most recently, the antero-oblique trajectory has been introduced, providing yet another corridor to access the lumbar spine. Termed the oblique lumbar interbody fusion, this approach accesses the spine between the anterior vessels and psoas muscles, avoiding both sets of structures to allow efficient clearance of the disc space and application of a large interbody device to afford distraction for foraminal decompression and endplate preparation for rapid and thorough fusion. This review aims to summarize the early clinical results and complications of this new technique and discusses potential future directions of research.
10.1016/j.jocn.2016.02.030
[The mono- and multisegmental ventral minimally invasive approach to the lumbar spine (OLIF) in lumbar deformities].
Mehren Christoph,Wanke-Jellinek Lorenz,Krenauer Alexander,Korge Andreas
Operative Orthopadie und Traumatologie
OBJECTIVE:Minimally invasive anterolateral approach to the lumbar spine (oblique lateral interbody fusion, OLIF) to correct lumbar deformities. INDICATIONS:Ventral release in degenerative lumbar scoliosis or segmental kyphosis and intervertebral spondylodesis. CONTRAINDICATIONS:No absolute contraindications. Relative contraindications are previous (left-sided) retroperitoneal interventions or status after peritonitis with pronounced retroperitoneal scarring. Vascular anomalies with extremely lateral common iliac vein (especially with segmentation disorders in the penultimate mobile segment). SURGICAL TECHNIQUE:Through a small skin incision in the left abdominal wall and alternating incision technique through the abdominal wall muscles retroperitoneal approach to the lateral anterior lumbar spine monosegmental or from L1-L5 multisegmental if needed. Retraction of the psoas muscle and removal of the intervertebral disc space, if necessary with resection of the anterior longitudinal ligament. Intervertebral release and interposition of an implant for ventral spondylodesis. POSTOPERATIVE MANAGEMENT:Early mobilisation after dorsal instrumentation under thrombosis prophylaxis. Light meals until the first bowel movement. Wearing a trunk stabilizing brace for up to 12 weeks, depending on the type and extent of the procedure. No limitations regarding walking distance, standing and sitting immediately postoperatively. RESULTS:In all, 15 patients with degenerative lumbar scoliosis were treated with ventrodorsal fusion surgery. The surgical anterior treatment included 1-4 segments. The access-specific complications and pre- and postoperative radiological parameters were recorded. None of the 15 left-sided retroperitoneal ventral accesses showed intraoperative or postoperative access-specific complications. A significant reduction of the anteroposterior Cobb angle from 16° ± 6° preoperatively to 3° ± 2° postoperatively (p < 0.001) was achieved in the entire patient population.
10.1007/s00064-020-00658-8
Mini-open oblique lumbar interbody fusion (OLIF) approach for multi-level discectomy and fusion involving L5-S1: Preliminary experience.
Zairi F,Sunna T P,Westwick H J,Weil A G,Wang Z,Boubez G,Shedid D
Orthopaedics & traumatology, surgery & research : OTSR
STUDY DESIGN:Technical description and single institution retrospective case series. OBJECTIVE:Evaluate technical feasibility and evaluate complications of mini-open retroperitoneal oblique lumbar interbody fusion (OLIF) at the L5-S1 level. SUMMARY OF BACKGROUND:The mini-open retroperitoneal oblique lumbar interbody fusion (OLIF) approach was first described in 2012 as a surgical approach to achieve spinal fusion while limiting invasiveness of the exposure to the anterior lumbar spine. Surgeons who use this approach, along with those who described it in cadaveric studies describe it as a feasible approach in targeting the L2 down to the L5 level and recommend alternative approaches to the L5-S1 level due to the vascular challenges and possible complications. METHODS:Technical description and single institution case series of patients treated with the OLIF between 2013 and 2015 at the L5-S1 level. The previously described surgical approach was modified by identifying and ligating the iliolumbar vein before retracting the iliac artery and vein anteriorly instead of passing between the vessels. RESULTS:Six patients (3 males, 3 females, mean age 62 years) were operated between 2013 and 2015. There were no vascular injuries or peripheral nerve trauma associated with the surgical procedure. Complications associated with the procedure included: cage displacement immediately postoperative requiring re-operation in one patient, transient psoas weakness in one patient, extended hospital stay for pain control in one patient, and transfusion was required in one patient. CONCLUSIONS:Mini-open retroperitoneal oblique lumbar interbody fusion is feasible at the L5-S1 level with limited vascular complications through a technical modification for safe mobilization of the iliac vessels by first ligating the iliolumbar vein.
10.1016/j.otsr.2016.11.016