Technical Description of Oblique Lateral Interbody Fusion at L1-L5 (OLIF25) and at L5-S1 (OLIF51) and Evaluation of Complication and Fusion Rates

• Published in: The spine journal Vol. 17; no. 4; pp. 545 - 553
• Main Authors: Woods, Kamal R.M., MD, Billys, James B., MD, Hynes, Richard A., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-04-2017
• Subjects: Anterior lumbar interbody fusion (ALIF); Complication rates; CT fusion rates; Direct lateral interbody fusion (DLIF); Extreme lateral interbody fusion (XLIF); Humans; Lateral lumbar interbody fusion (LLIF); Lumbar Vertebrae - surgery; Minimally invasive lumbar fusion; Oblique lateral interbody fusion (OLIF); Oblique lateral retroperitoneal approach; Orthopedics; Pain, Postoperative - etiology; Psoas Muscles - surgery; Reoperation - statistics & numerical data; Spinal Fusion - adverse effects; Spinal Fusion - methods; Vascular System Injuries - etiology; minimally invasive lumbar fusion; oblique lateral retroperitoneal approach; CT fusion rates; direct lateral interbody fusion (DLIF); oblique lateral interbody fusion (OLIF); lateral lumbar interbody fusion (LLIF); anterior lumbar interbody fusion (ALIF); extreme lateral interbody fusion (XLIF); complication rates; Complication rates; Direct lateral interbody fusion (DLIF); Oblique lateral retroperitoneal approach; Minimally invasive lumbar fusion; Oblique lateral interbody fusion (OLIF); Anterior lumbar interbody fusion (ALIF); Lateral lumbar interbody fusion (LLIF); Extreme lateral interbody fusion (XLIF)
• ISSN: 1529-9430; 1878-1632
• DOI: 10.1016/j.spinee.2016.10.026

Abstract Background The OLIF procedure is aimed at mitigating some of the challenges seen with traditional ALIF and transpsoas LLIF and allows for interbody fusion at L1-S1. Purpose To describe the OLIF technique and assess the complication and fusion rates. Study Design A retrospective cohort study. Patient Sample 137 patients who underwent the oblique lateral interbody fusion (OLIF) procedure. Outcome measures Adverse events within 6 months of surgery: Infection, symptomatic pseudarthrosis, hardware failure, vascular injury, perioperative blood transfusion, ureteral injury, bowel injury, renal injury, prolonged postoperative ileus (greater than 3 days), incisional hernia, pseudohernia, reoperation, neurological deficits (weakness, numbness, paresthesia), hip flexion pain, retrograde ejaculation, sympathectomy affecting lower extremities, deep vein thrombosis, pulmonary embolism, myocardial infarction, pneumonia, and cerebrovascular accident. Fusion and subsidence rates based on CT done at 6 months postoperatively. Methods Retrospective chart review of 150 consecutive patients was performed to examine the complications associated with OLIF at L1-L5 (OLIF25), OLIF at L5-S1 (OLIF51) and OLIF at L1-5 combined with OLIF at L5-S1 (OLIF25 + OLIF51). Only patients who had a minimum of 6 months follow-up, including CT scan at 6 months after surgery, were included. Independent radiology review of CT data was performed to assess fusion and subsidence rates at 6 months. Results A total of 137 patients underwent fusion at 340 levels. An overall complication rate of 11.7% was seen. The most common complications were subsidence (4.4%), postoperative ileus (2.9%) and vascular injury (2.9%). Ileus and vascular injury were only seen in cases including OLIF51. No patient suffered neurological injury. No cases of ureteral injury, sympathectomy affecting the lower extremities or visceral injury were seen. Successful fusion was seen at 97.9% of surgical levels. Conclusion OLIF is a safe procedure at L1-5 as well as L5-S1. The complication profile appears acceptable when compared to LLIF and ALIF. The oblique trajectory mitigates psoas muscle and lumbosacral plexus-related complications seen with the lateral transpsoas approach. Furthermore, there is a high fusion rate based on CT data at 6 months.