Yonsei Med J.  2015 Jul;56(4):1051-1059. 10.3349/ymj.2015.56.4.1051.

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

• Ohtori S
• Orita S
• Yamauchi K
• Eguchi Y
• Ochiai N
• Kishida S
• Kuniyoshi
• Aoki Y
• Nakamura J
• Ishikawa T
• Miyagi M
• Kamoda H
• Suzuki M
• Kubota G
• Sakuma Y
• Oikawa Y
• Inage K
• Sainoh T
• Sato J
• Fujimoto K
• Shiga Y
• Abe K
• Toyone T
• Inoue G
• Takahashi

• KMID: 2366348
• DOI: http://doi.org/10.3349/ymj.2015.56.4.1051

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.

Keyword

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

MeSH Terms

Adult
Aged
Decompression, Surgical/*methods
Electromyography
Female
Humans
Lumbar Vertebrae/surgery
Male
Middle Aged
Pain
Pain Measurement
Scoliosis/*surgery
Spinal Diseases/surgery
Spinal Fusion/*methods
Spondylolisthesis/*surgery
Treatment Outcome
Young Adult

Figure

• 

  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 (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 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 (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 (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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