scholarly journals Analysis of The Correction Capability of Oblique Lumbar Interbody Fusion Approach to Improving The Lenke-Silva Classification in First-Stage MIS Adult Spinal Deformity Corrections

2021 ◽  
Author(s):  
Leo Shaw ◽  
Yu-Tsung Lin ◽  
Yun-Che Wu ◽  
Cheng-Min Shih ◽  
Chien-Chou Pan ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Posterior Instrumentation ◽  
Adult Spinal Deformity ◽  
Complication Rates ◽  
Lumbar Interbody Fusion ◽  
Two Stage ◽  
Cage Subsidence ◽  
Group A ◽  
Oblique Lumbar Interbody Fusion ◽  
Group B

Abstract BackgroundA two-stage minimally invasive surgery (MIS) protocol with oblique lumbar interbody fusion (OLIF) combined with posterior instrumentation is becoming popular in the treatment of adult spinal deformities (ASDs) because of lower complication rates and less blood loss when compared with the open traditional posterior approach. The objective of this study is to determine the efficacy of correction and the causes of suboptimal correction in two-stage OLIF.MethodsThis retrospective study included 27 patients who underwent both two-stage and single-stage OLIF with posterior instrumentation for treatment of ASD. Patients treated with two-stage OLIF were sorted into Group A (Improved Lenke-Silva classification after the first-stage OLIF) and Group B (Unchanged Lenke-Silva classification after the first-stage operation) to evaluate the correction efficacy of OLIF in a two-stage MIS protocol. Statistical analyses were performed to compare the clinical and radiological outcomes. The causes of complications and suboptimal corrections (Group B) in patients treated with the two-stage MIS protocol were analyzed.ResultsAll 27 patient patients showed significant improvement (P < 0.05) in the visual analog scale, the Oswestry Disability Index, and EuroQol. A total of 14 patient were treated with the two-stage protocol, with ten patients included in group A and four patients with insufficient correction angles included in group B. The radiographic outcome of Group A showed significant corrections (P < 0.05) in pelvic tilt, pelvic incidence-lumbar lordosis (PI-LL) mismatch, sagittal vertical axis, and max Cobb angles. In group B, surgical limitations of OLIF were the cause of unsatisfactory correction in two patients because the deformities involved the T-L junction, which was not accessible using the approach. Severe preoperative PI-LL mismatch (41°) and cage subsidence with an anterior endplate fracture were the cause of poor correction in two other patients.ConclusionOLIF can provide significant corrections that reduce the need for a Smith-Petersen osteotomy (SPO) or a pedicular subtraction osteotomy (PSO) for additional correction during posterior instrumentation. Deformities involving the T-spine or T-L junction, severe PI-LL mismatches, and cage subsidence are the possible causes of suboptimal corrections with OLIF using the two-stage protocol.

scholarly journals Prevalence and location of endplate fracture and subsidence after oblique lumbar interbody fusion for adult spinal deformity

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Gen Inoue ◽  
Wataru Saito ◽  
Masayuki Miyagi ◽  
Takayuki Imura ◽  
Eiki Shirasawa ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Interbody Fusion ◽  
Sagittal Plane ◽  
Adult Spinal Deformity ◽  
Major Complication ◽  
Global Alignment ◽  
Lumbar Interbody Fusion ◽  
Significant Difference ◽  
Cage Subsidence ◽  
Oblique Lumbar Interbody Fusion

Abstract Background Recently, Oblique lumbar interbody fusion (OLIF) is commonly indicated to correct the sagittal and coronal alignment in adult spinal deformity (ASD). Endplate fracture during surgery is a major complication of OLIF, but the detailed location of fracture in vertebral endplate in ASD has not yet been determined. We sought to determine the incidence and location of endplate fracture and subsidence of the OLIF cage in ASD surgery, and its association with fusion status and alignment. Methods We analyzed 75 levels in 27 patients were analyzed using multiplanar CT to detect the endplate fracture immediately after surgery and subsidence at 1 year postoperatively. The prevalence was compared between anterior and posterior, approach and non-approach sides, and concave and convex side. Their association with fusion status, local and global alignment, and complication was also investigated. Results Endplate fracture was observed in 64 levels (85.3%) in all 27 patients, and the incidence was significantly higher in the posterior area compared with the anterior area (85.3 vs. 68.0%, p=0.02) of affected vertebra in the sagittal plane. In the coronal plane, there was no significant difference in incidence between left (approach) and right (non-approach) sides (77.3 and 81.3%, respectively), or concave and convex sides (69.4 and 79.6%) of wedged vertebra. By contrast, cage subsidence at 1 year postoperatively was noted in 14/75 levels (18.7%), but was not associated with endplate fracture. Fusion status, local and global alignment, and complications were not associated with endplate fracture or subsidence. Conclusion Endplate fracture during OLIF procedure in ASD cases is barely avoidable, possibly induced by the corrective maneuver with ideal rod counter and cantilever force, but is less associated with subsequent cage subsidence, fusion status, and sustainment of corrected alignment in long fusion surgery performed even for elderly patients.

scholarly journals Biomechanical Evaluation of Anterolateral Screw Fixation for Oblique Lumbar Interbody Fusion Surgery – A Finite Element Analysis

2020 ◽  
Author(s):  
gufang Fang ◽  
SG Chen ◽  
wda zhuang ◽  
WH Huang ◽  
Hongxun Sang
Keyword(s):  
Finite Element ◽  
Interbody Fusion ◽  
Screw Fixation ◽  
Upper Body ◽  
Lumbar Interbody Fusion ◽  
Element Analysis ◽  
Flexion Extension ◽  
Cage Subsidence ◽  
Oblique Lumbar Interbody Fusion ◽  
Maximum Stresses

Abstract Background: The most common complication of oblique lumbar interbody fusion (OLIF) is cage subsidence. OLIF combined with internal fixation could help decrease the cage subsidence and increase the fusion rate. The aim of this study was to evaluate the biomechanical feasibility and safety in the patients undergoing OLIF surgery with anterolateral screw fixation (ASF). Methods: Based on our previous validated model , L4-L5 functional surgical models corresponding to the ASF and Bilateral pedicle screw fixation(BPSF) methods were created. A 500 N compression force was applied to the superior surface of the model to represent the upper body weight, and a 7.5 Nm moment was applied to simulate the six movement directions of the lumbar spinal model: flexion/extension, right/left lateral bending and right/left axial rotation. Finite element (FE) models were developed to compare the biomechanics of the ASF and BPSF groups. Results: Compared to the range of motion (ROM) of the intact lumbar model, that of the ASF model was decreased by 82.0% in flexion, 60.0% in extension, and the BPSF model was decreased by 86.7% in flexion, 77.3% in extension. Compared to the BPSF model, the maximum stresses of the L4 inferior endplate (IEP) and L5 superior endplate (SEP) were greatly increased in the ASF model; The contact surface between vertebrae and screw (CSVS) in the ASF model produced nearly100% more stresses than the BPSF model in all moment .Conclusions: OLIF surgery with ASF could not reduce the maximum stresses on the endplate and CSVS, which may be a potential risk factor for cage subsidence and screw loosening.

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 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 Posterior Lumbar Interbody Fusion in Degenerative Lumbar Spine Disease and Risk of Adjacent Segment Disease

2020 ◽  
Vol 24 (2) ◽  
Author(s):  
IJAZ HUSSAIN WADD ◽  
ASIF SHABIR ◽  
LIAQAT MEHMOOD AWAN ◽  
SYED MOHSIN AJMAL ◽  
HUMAIRA MUSHTAQ ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Adjacent Segment Disease ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Disc Space ◽  
Age Related ◽  
Significant Difference ◽  
Group A ◽  
Group B

Objective:  To determine the chances of adjacent segment disease (ASD) and risk factors after posterior lumbar interbody fusion (PLIF). Material and Methods: 110 patients of both genders with degenerative lumbar instability at L4/5 level were included in my study. We did PLIF in all our patients and followed our patients for one year. The following parameters were measured: the degree of lumbar lordosis, the degree lumbosacral angle, the disc space height and their dynamic angulation and the displacement of L3 over L4. We checked the outcome with the help of the Japanese orthopedic association (JOA) and Oswestry disability index (ODI). We divided the patients into groups A and B; group A includes patients with progression of degeneration at the proximal level (L3-L4), while group B with no progression of disease at proximal level. Results:  The 86 patients (78.18%) were in group A, and 24 patients (21.88%) were in group B. There were no significant difference in radiological parameters of both groups; lumbosacral angle of lordosis, L3 laminar inclination angle, preoperative degenerative changes at proximal level, L4–L5 lordosis and BMD before surgery. The clinically and statistically significant differenceswere of the age of the patients falling in two groups. We found that at the completion of study ODI and JOA were not significantly different in both groups (P >0.05). Conclusion:  Degenerative lumbar disease is an age related disease with no significant effect of radiological degenerations on the final outcome of our patients.No other possible risk factor has a significant effect on outcome.

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.

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