Complications and Morbidities of Mini-open Anterior Retroperitoneal Lumbar Interbody Fusion: Oblique Lumbar Interbody Fusion in 179 Patients

Abstract

Study design: A retrospective study including 179 patients who underwent oblique lumbar interbody fusion (OLIF) at one institution.

Purpose: To report the complications associated with a minimally invasive technique of a retroperitoneal anterolateral approach to the lumbar spine.

Overview of literature: Different approaches to the lumbar spine have been proposed, but they are associated with an increased risk of complications and a longer operation.

Methods: A total of 179 patients with previous posterior instrumented fusion undergoing OLIF were included. The technique is described in terms of: the number of levels fused, operative time and blood loss. Persurgical and postsurgical complications were noted.

Results: Patients were age 54.1 ± 10.6 with a BMI of 24.8 ± 4.1 kg/m(2). The procedure was performed in the lumbar spine at L1-L2 in 4, L2-L3 in 54, L3-L4 in 120, L4-L5 in 134, and L5-S1 in 6 patients. It was done at 1 level in 56, 2 levels in 107, and 3 levels in 16 patients. Surgery time and blood loss were, respectively, 32.5 ± 13.2 minutes and 57 ± 131 ml per level fused. There were 19 patients with a single complication and one with two complications, including two patients with postoperative radiculopathy after L3-5 OLIF. There was no abdominal weakness or herniation.

Conclusions: Minimally invasive OLIF can be performed easily and safely in the lumbar spine from L2 to L5, and at L1-2 for selected cases. Up to 3 levels can be addressed through a 'sliding window'. It is associated with minimal blood loss and short operations, and with decreased risk of abdominal wall weakness or herniation.

Keywords: Anterior approach; Interbody fusion; Lumbar spine; Minimally invasive surgery.

Fig. 1

(A) A 4-cm skin incision (solid arrow) was made in the lateral abdominal region along the fibers of the external oblique muscle. The level of the L4-5 disc (dotted arrow) was located using the C-arm. (B) External oblique, internal oblique, and transverse abdominal muscles are dissected along the direction of their fibers. (C) The intervertebral disc is exposed using handheld retractors and Steinman pins. (D) Skin closure.

Fig. 2

(A) Exposure of disc space. (B) Filling of banana-shaped polyetheretherketone cage using bone substitute. (C) Cage inserted into exposed disc space after endplate preparation.

Fig. 3

Preoperative (A, B) and postoperative (C, D) radiographs of a 45-year-old female with degenerative scoliosis undergoing three-level oblique lumbar interbody fusion, showing the presence radio-opaque markers of the interbody cages from L2 to L5 (arrows).

Fig. 4

Postoperative radiographs of two different patients undergoing oblique lumbar interbody fusion at L1-3 (A, B) and L4-S1 (C, D). Full arrows show the presence radio-opaque markers of the interbody cages.