Oblique Lumbar Interbody Fusion From L2 to S1: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Gregory A Kuzmik ◽  
Thomas A Wozny ◽  
Simon Ammanuel ◽  
Charles M Eichler ◽  
Praveen V Mummaneni ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Deformity Correction ◽  
Lateral Position ◽  
Lumbar Interbody Fusion ◽  
Blunt Dissection ◽  
Disc Space ◽  
Vascular Surgeon ◽  
Transpsoas Approach ◽  
Oblique Lumbar Interbody Fusion ◽  
Oblique Approach

Abstract This surgical video demonstrates the technique of an oblique lumbar interbody fusion (OLIF) in the lumbar spine from L2 to L5 as well as an oblique approach to the L5-S1 level. It demonstrates the surgical approach, technical nuances of OLIF, and pearls of the surgery. The video discusses the importance of the release of the disc space to allow for height restoration and deformity correction, endplate preparation to enhance arthrodesis, and appropriate implant sizing. The concept of the approach is the minimally invasive blunt dissection through the abdominal wall musculature and mobilization of the retroperitoneal fat. Unlike the transpsoas approach, the surgery is performed anterior to the psoas, avoiding the lumbar plexus.1 For L5-S1, the approach is still performed in the lateral position but with an oblique approach. A vascular surgeon performs the L5-S1 approach, and the disc space is accessed through the iliac bifurcation.2 The discectomy and interbody fusion are performed similarly to a standard anterior lumbar interbody fusion (ALIF), but in a lateral position and at an oblique angle. The patient consented to this procedure and for filming a video of this case.

scholarly journals Minimally invasive L5–S1 oblique lumbar interbody fusion with anterior plate

2016 ◽  
Vol 41 (videosuppl1) ◽  
pp. 1
Author(s):  
Martin H. Pham ◽  
Andre M. Jakoi ◽  
Patrick C. Hsieh
Keyword(s):  
Minimally Invasive ◽  
Degenerative Disc Disease ◽  
Interbody Fusion ◽  
Deformity Correction ◽  
Lumbar Interbody Fusion ◽  
Degenerative Scoliosis ◽  
Anterior Plate ◽  
Disc Disease ◽  
Case Presentation ◽  
Oblique Lumbar Interbody Fusion

Lumbar interbody fusion is an important technique for the treatment of degenerative disc disease and degenerative scoliosis. The oblique lumbar interbody fusion (OLIF) establishes a minimally invasive retroperitoneal exposure anterior to the psoas and lumbar plexus. In this video case presentation, the authors demonstrate the techniques of the OLIF at L5–S1 performed on a 69-year-old female with degenerative scoliosis as one component of an overall strategy for her deformity correction.The video can be found here: https://youtu.be/VMUYWKLAl0g.

scholarly journals Efficacy and radiographic analysis of oblique lumbar interbody fusion in treating adult spinal deformity

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257316
Author(s):  
Dae-Jean Jo ◽  
Eun-Min Seo
Keyword(s):  
Spinal Deformity ◽  
Interbody Fusion ◽  
Adult Spinal Deformity ◽  
Deformity Correction ◽  
Lumbar Interbody Fusion ◽  
Spinal Fixation ◽  
Invasive Approach ◽  
Radiographic Parameters ◽  
Oblique Lumbar Interbody Fusion

Adult spinal deformity (ASD) is usually rigid and requires a combined anterior–posterior approach for deformity correction. Anterior lumbar interbody fusion (ALIF) allows direct access to the disc space and placement of a large interbody graft. A larger interbody graft facilitates correction of ASD. However, an anterior approach carries significant risks. Lateral lumbar interbody fusion (LLIF) through a minimally invasive approach has recently been used for ASD. The present study was performed to evaluate the effectiveness of oblique lumbar interbody fusion (OLIF) in the treatment of ASD. We performed a retrospective study utilizing the data of 74 patients with ASD. The inclusion criteria were lumbar coronal Cobb angle > 20°, pelvic incidence (PI)–lumbar lordosis (LL) mismatch > 10°, and minimum follow–up of 2 years. Patients were divided into two groups: ALIF combined with posterior spinal fixation (ALIF+PSF) (n = 38) and OLIF combined with posterior spinal fixation (OLIF+PSF) (n = 36). The perioperative spinal deformity radiographic parameters, complications, and health-related quality of life (HRQoL) outcomes were assessed and compared between the two groups. The preoperative sagittal vertical axis (SVA), LL, PI–LL mismatch, and lumbar Cobb angles were similar between the two groups. Patients in the OLIF+PSF group had a slightly higher mean number of interbody fusion levels than those in the ALIF+PSF group. At the final follow–up, all radiographic parameters and HRQoL scores were similar between the two groups. However, the rates of perioperative complications were higher in the ALIF+PSF than OLIF+PSF group. The ALIF+PSF and OLIF+PSF groups showed similar radiographic and HRQoL outcomes. These observations suggest that OLIF is a safe and reliable surgical treatment option for ASD.

scholarly journals Oblique Lumbar Interbody Fusion at the L5-S1 Segment via an Approach Between the Psoas Muscle and the Great Vessels: Technique Note and Case Presentations.

2020 ◽  
Author(s):  
Xigong Li ◽  
Weiyi Diao ◽  
Yuzhu Zhang ◽  
Junsong Wu ◽  
Chunyang Xing ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Perioperative Complications ◽  
Psoas Muscle ◽  
Common Iliac Vein ◽  
Type I ◽  
Lumbar Interbody Fusion ◽  
Disc Space ◽  
Type Iii ◽  
Great Vessels ◽  
Oblique Lumbar Interbody Fusion

Abstract Study DesignTechnique note.ObjectivesTo describe our modified oblique lumbar interbody fusion (OLIF) technique in the reconstruction of the L5-S1 segment.Summary of Background DataRecently, OLIF has been generally recognized as an effective procedure in the treatment of various spinal pathologies at L2-L5 segments. However, the usage of OLIF at the L5-S1 segment doesn’t have gained widespread acceptance in spine community. Some authors still concern about the feasibility of OLIF used in lumbosacral fusionMethodsTen consecutive patients underwent L5-S1 interbody fusion using the OLIF technique in our institution. The L5–S1 disc space is approached via one retroperitoneal oblique corridor between the psoas muscle and the great vessels. The discectomy and endplate preparation are performed through a surgical window developed on the anterolateral side of L5-S1 disc. A secondary cage insertion technique is used for safe placement of interbody fusion cages.ResultsOf the 10 patients, 6 were males and 4 were females, with an average age of 55.4±6.8 years. There were 8 single-level and 2 two-level procedures, including 2 at L4–L5 and 10 at L5–S1. Preoperative axial MR images confirmed 1 patient with type I LCIV (left common iliac vein), 6 with type II LCIV and 3 with type III LCIV. The average blood loss was 133.4±88.5 ml, and the average operative times were 153.6±38.3 minutes. Postoperative radiographs examination confirmed all patients obtained a better reconstruction at the lumbosacral junction. Two patients with type III LCIV sustained iliolumbar vein laceration during the exposure, and no other perioperative complications were encountered.ConclusionOur novel OLIF L5-S1 technique is a more feasible procedure of lumbosacral fusion, which shared the common surgical plane with OLIF L2-5, allowing for L2 to S1 reproducible multi-levels interbody fusions via a retroperitoneal oblique corridor between the psoas muscle and the great vessels. Detailed preoperative plan and meticulous intraoperative manipulation are prerequisite for the success of OLIF L5-S1 procedure.

scholarly journals Oblique lumbar interbody fusion in management of lumbar degenerative spinal stenosis in Chinese population

2020 ◽  
Vol 27 (2) ◽  
pp. 119-127
Author(s):  
Man Yee Cheung ◽  
Philip Cheung
Keyword(s):  
Spinal Stenosis ◽  
Interbody Fusion ◽  
Posterior Instrumentation ◽  
Psoas Muscle ◽  
Chinese Patients ◽  
Lumbar Interbody Fusion ◽  
Disc Space ◽  
Lateral Incision ◽  
Oblique Lumbar Interbody Fusion ◽  
The Mean

Purpose: The purpose of this study was to assess the outcomes of a cohort of local Chinese patients who underwent oblique lumbar interbody fusion (OLIF) surgery for lumbar degenerative diseases. Methods: We adopted a minimally invasive anterior approach to the lumbar spine through retroperitoneal access. In the first part of the surgery, a 3- to 5-cm left lateral incision over the abdomen was made guided by imaging. L2–L5 disc space was approached via the corridor between the left psoas muscle and the great vessels. A specially designed interbody cage filled with bone substitute was utilized for interbody fusion. In the second part of the surgery, posterior instrumentation with or without decompression, was performed in a prone position. Efficacy and safety of the surgery were studied. Results: A total of 60 patients with the mean age of 68 years underwent OLIF at 83 surgical levels. Their mean operative time was 79 min, and the average blood loss was 84 ml for the OLIF part. The mean length of hospital stay was 5.5 days. Based on plain computed tomography scan obtained at post-operative 6 months, successful fusion was achieved in 82 of the 83 surgical levels. The Oswestry Disability Index for low back pain had a mean reduction of 22.3% after 6 months. Specific complications observed include transient thigh pain or numbness, retroperitoneal hematoma, post-operative ileus and Bone Morphogenetic Protein (BMP) osteolysis. None of the patients experienced infection, symptomatic pseudo-arthrosis, hardware failure, vascular injury, nerve injury, ureteral injury, bowel injury, incisional hernia or death. Conclusion: OLIF is an effective procedure to treat lumbar spinal stenosis and spondylolisthesis with excellent fusion rate and good functional outcome. Complications specific to this procedure are not uncommon, but majority are minor and self-recovery. Proper training is required to minimize potential surgical risks.

Simultaneous Robotic Single-Position Surgery With Oblique Lumbar Interbody Fusion With Software Planning: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Martin H Pham ◽  
Jillian Plonsker ◽  
Luis D Diaz-Aguilar ◽  
Joseph A Osorio ◽  
Ronald A Lehman
Keyword(s):  
Interbody Fusion ◽  
Posterior Instrumentation ◽  
Spinal Instrumentation ◽  
Lateral Position ◽  
Lateral Approach ◽  
Lumbar Interbody Fusion ◽  
Robotic Platform ◽  
Patient Consent ◽  
Oblique Lumbar Interbody Fusion ◽  
Lateral Interbody

Abstract The use of robotic guidance for spinal instrumentation is promising for its ability to offer the advantages of precision, accuracy, and reproducibility. This has become even more important in the era of lateral interbody surgery because spinal robotics opens up the possibility of a straightforward workflow for single-position surgery in the lateral position.  We present here a case of a 72-yr-old woman who presented with an L4-5 spondylolisthesis with axial back pain and radiculopathy. She subsequently underwent an L4-5 oblique lumbar interbody fusion with L4-5 bilateral posterior instrumentation in a single lateral position (Mazor X Stealth Edition, Medtronic Sofamor Danek, Medtronic Inc, Dublin, Ireland). Due to the oblique lateral approach and posterior robotic assistance, both surgeons were able to work simultaneously for increased efficiency. To our knowledge, this is the first video demonstrating a two-surgeon simultaneous robotic single-position surgery with oblique lumbar interbody fusion using a spinal robotic platform.  There is no identifying information in this video. Patient consent was obtained for the surgical procedure and for publishing of the material included in the video.

scholarly journals Navigated oblique lumbar interbody fusion for adult spinal deformity

2020 ◽  
Vol 2 (1) ◽  
pp. V7
Author(s):  
Chih-Chang Chang ◽  
Joshua Rivera ◽  
Brenton Pennicooke ◽  
Dean Chou ◽  
Praveen V. Mummaneni
Keyword(s):  
Spinal Deformity ◽  
Interbody Fusion ◽  
Adult Spinal Deformity ◽  
Deformity Correction ◽  
Computer Assisted ◽  
Lumbar Interbody Fusion ◽  
Disease Entity ◽  
Assisted Navigation ◽  
Reduce Radiation Exposure ◽  
Oblique Lumbar Interbody Fusion

Adult spinal deformity (ASD) is an increasing disease entity as the population ages. An emerging minimally invasive surgery (MIS) option for the treatment of ASD is the oblique lumbar interbody fusion (OLIF), which allows indirect foraminal decompression of stenosis as well as segmental deformity correction (DiGiorgio et al., 2017). The authors utilize computer-assisted navigation with OLIF to reduce radiation exposure and improve time efficiency. The authors present a video of navigated oblique lumbar interbody fusion at L3–5 followed by open posterior screw-rod fixation.The video can be found here: https://youtu.be/zKDT7PhMYf8.

scholarly journals Expandable Cage Technology—Transforaminal, Anterior, and Lateral Lumbar Interbody Fusion

2021 ◽  
Vol 21 (Supplement_1) ◽  
pp. S69-S80
Author(s):  
Mohamed Macki ◽  
Travis Hamilton ◽  
Yazeed W Haddad ◽  
Victor Chang
Keyword(s):  
Interbody Fusion ◽  
Surgical Techniques ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Disc Space ◽  
Lateral Lumbar Interbody Fusion ◽  
Transpsoas Approach ◽  
Risk Of Injury ◽  
Invasive Techniques ◽  
Neurovascular Structures

Abstract This review of the literature will focus on the indications, surgical techniques, and outcomes for expandable transforaminal lumbar interbody fusion (TLIF), anterior lumbar interbody fusion (ALIF), and lateral lumbar interbody fusion (LLIF) operations. The expandable TLIF cage has become a workhorse for common degenerative pathology, whereas expandable ALIF cages carry the promise of greater lordotic correction while evading the diseased posterior elements. Expandable LLIF cages call upon minimally invasive techniques for a retroperitoneal, transpsoas approach to the disc space, obviating the need for an access surgeon and decreasing risk of injury to the critical neurovascular structures. Nuances between expandable and static cages for all 3 TLIF, ALIF, and LLIF operations are discussed in this review.

scholarly journals Complications Associated With Oblique Lumbar Interbody Fusion at L5-S1: A Systematic Review of the Literature

2021 ◽  
Vol 2 (3) ◽  
Author(s):  
Martin H Pham ◽  
Omron Hassan ◽  
Luis Daniel Diaz-Aguilar ◽  
Ronald A Lehman
Keyword(s):  
Systematic Review ◽  
Minimally Invasive ◽  
Complication Rate ◽  
Interbody Fusion ◽  
Assessment Tool ◽  
Deformity Correction ◽  
Injury Rate ◽  
Neurological Injury ◽  
Lumbar Interbody Fusion ◽  
Oblique Lumbar Interbody Fusion

Abstract INTRODUCTION Oblique lumbar interbody fusion (OLIF) at L5-S1, also known as a lateral decubitus anterior lumbar interbody fusion (ALIF) or anterior-to-psoas (ATP) approach, is a technique that provides a minimally invasive corridor to a key segment in the spine for degenerative conditions and deformity correction. However, the evaluation of complications associated with this level has been difficult as prior reports include other levels that have different anatomic considerations. OBJECTIVE To present a systematic review of previously reported cases of OLIF, lateral ALIF, and an ATP approach at L5-S1 to discuss their associated complications. METHODS Following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, a PubMed search was performed up to January 2021 to identify literature describing OLIF, lateral ALIF, and ATP approaches involving the L5-S1 levels. A quality assessment with risk of bias analysis was performed using the methodological index for non-randomized studies (MINORS) assessment tool for each study. Data we then extracted to identify all complications. RESULTS The initial search yielded 532 publications. After screening, there were 18 studies with 553 total patients who underwent OLIF including L5-S1. Analysis of these studies demonstrated a vascular complication rate of 2.5%, bowel-associated complication rate of 0.5%, ureteral injury rate of 0%, neurological injury rate of 1.9%, pseudarthrosis rate of 7.3%, and reoperation rate of 2.2%. CONCLUSION The L5-S1 level remains an important target for sagittal alignment in both degenerative and deformity surgery. The OLIF surgical corridor to this level presents special anatomic and clinical considerations and is a safe approach to minimize morbidity with minimally invasive access.

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