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. 2015 Jul;56(4):1051-9.
doi: 10.3349/ymj.2015.56.4.1051.

Mini-Open Anterior Retroperitoneal Lumbar Interbody Fusion: Oblique Lateral Interbody Fusion for Lumbar Spinal Degeneration Disease

Seiji Ohtori  1 , Sumihisa Orita  2 , Kazuyo Yamauchi  2 , Yawara Eguchi  2 , Nobuyasu Ochiai  2 , Shunji Kishida  2 , Kazuki Kuniyoshi  2 , Yasuchika Aoki  2 , Junichi Nakamura  2 , Tetsuhiro Ishikawa  2 , Masayuki Miyagi  2 , Hiroto Kamoda  2 , Miyako Suzuki  2 , Gou Kubota  2 , Yoshihiro Sakuma  2 , Yasuhiro Oikawa  2 , Kazuhide Inage  2 , Takeshi Sainoh  2 , Jun Sato  2 , Kazuki Fujimoto  2 , Yasuhiro Shiga  2 , Koki Abe  2 , Tomoaki Toyone  2 , Gen Inoue  2 , Kazuhisa Takahashi  2
Affiliations

Mini-Open Anterior Retroperitoneal Lumbar Interbody Fusion: Oblique Lateral Interbody Fusion for Lumbar Spinal Degeneration Disease

Seiji Ohtori et al. Yonsei Med J. 2015 Jul.

Abstract

Purpose: Surgery for lumbar spinal degeneration disease is widely performed. While posterior decompression and fusion are popular, anterior lumbar interbody fusion (ALIF) is also used for treatment. Extreme lateral interbody fusion (XLIF) is commonly used for noninvasive ALIF; however, several complications, such as spinal nerve and psoas muscle injury, have been reported. In the current study, we examined the clinical efficacy and complications of oblique lateral interbody fusion (OLIF) for lumbar spinal degeneration disease.

Materials and methods: Thirty-five patients with degenerated spondylolisthesis, discogenic pain, and kyphoscoliosis were examined. All patients underwent OLIF surgery (using a cage and bone graft from the iliac crest) with or without posterior decompression, without real-time electromyography monitoring. Posterior screws were used in all patients. Visual analog scale (VAS) score and Oswestry Disability Index (ODI) were evaluated before and 6 months after surgery. Surgical complications were also evaluated.

Results: Pain scores significantly improved after surgery, compared to those before surgery (p<0.05). There was no patient who underwent revision surgery. There was no spinal nerve, major vessel, peritoneal, or urinary injury. Few patients showed symptoms from psoas invasion.

Conclusion: OLIF surgery produced good surgical results without any major complication.

Keywords: Oblique lateral interbody fusion; decompress; degeneration disease; injury; lumbar; nerve; surgery.

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Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

Fig. 1
Fig. 1. Approaches to OLIF, XLIF, and DLIF. DLIF and XLIF present a lower risk of vessel or peritoneal injury but an increased risk of injury to spinal nerves or psoas muscles. OLIF is an anterior-psoas approach. OLIF, oblique lateral interbody fusion; XLIF, extreme lateral interbody fusion; DLIF, direct lateral interbody fusion.
Fig. 2
Fig. 2. (A) Skin marking to check the disc level using a C-arm X-ray imager. The skin incision was made 6 to 10 cm anterior to the mid portion of the disc. (A and B) Longitudinal incision from 3 to 4 cm is recommended. (C) Retractor for OLIF. (D) Clydesdale Spinal System cage filled with autologous bone is implanted. (E) Implantation technique. Implantation starts from a lateral oblique direction; finally the cage is inserted from a true lateral direction. OLIF, oblique lateral interbody fusion.
Fig. 3
Fig. 3. A 68-year-old woman showing spondylolisthetic degeneration at L4. MRI (A and B) and myelography (C) showing spondylolisthetic degeneration at L4 and spinal stenosis at L4-5. After surgery (OLIF and percutaneous pedicle screws without posterior decompression), disc height, spondylolisthesis, and stenosis improved on myelography (D). OLIF, oblique lateral interbody fusion.
Fig. 4
Fig. 4. (A) A 74-year-old woman showing kyphosis and discogenic pain. X-ray image showing severe kyphosis from L3 to L5. (B) MRI showing disc degeneration and Modic type 1 and 3 change at L4 and L5 vertebrae. (C) Surgery (OLIF and percutaneous pedicle screws without posterior decompression) improved the kyphosis. OLIF, oblique lateral interbody fusion.
Fig. 5
Fig. 5. (A and B) A 78-year-old woman showing kyphoscoliosis. X-ray images showing kyphoscoliosis. (C and D) Surgery (OLIF and percutaneous pedicle screws without posterior decompression) improved the kyphoscoliosis. (E) Photo before surgery. (F) Photo after surgery. OLIF, oblique lateral interbody fusion.
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