Elsevier

World Neurosurgery

Volume 98, February 2017, Pages 113-123
World Neurosurgery

Original Article
Oblique Lumbar Interbody Fusion: Technical Aspects, Operative Outcomes, and Complications

https://doi.org/10.1016/j.wneu.2016.10.074Get rights and content

Objective

Anterior lumbar interbody fusion (ALIF) and lateral lumbar interbody fusion (LLIF) are commonly used approaches for lumbar spine fusion surgery, each with their own unique advantages and disadvantages. ALIF requires mobilization of the great vessels and peritoneum, and dissection of the psoas muscle in the LLIF technique is associated with postoperative neurologic complications in the proximal lower limb. The anterior-to-psoas (ATP) or oblique lumbar interbody fusion (OLIF) technique is the proposed solution to accessing the L1-L5 levels without the issues encountered with ALIF and LLIF. In this review, the technical nuances, operative outcomes, and complications with the ATP/OLIF technique in the current literature are summarized.

Methods

A systematic search of the literature was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Data collected included operative time, blood loss, postoperative hospital stay, and complications, which were then pooled together.

Results

From the 16 studies selected, the mean blood loss was 109.9 mL, average operating time was 95.2 minutes, and mean postoperative hospital stay was 6.3 days. Fusion was achieved in 93% of levels operated. Incidence of intraoperative and postoperative complications was 1.5% and 9.9%, respectively. Transient thigh pain and/or numbness and hip flexion weakness occurred in 3.0% and 1.2% of patients, respectively.

Conclusions

Early results on the ATP/OLIF technique are promising and warrant further investigation with well-designed prospective randomized studies to provide high-level evidence of the potential advantages over the ALIF and LLIF approaches.

Introduction

Lumbar interbody fusion (LIF) is an effective procedure for management of various spinal diseases including lumbar degenerative disease, spinal deformities, trauma, infections, and neoplasms.1, 2 There are many approaches to performing LIF, each with their own unique profile of advantages and disadvantages. Anterior lumbar interbody fusion (ALIF) and lateral lumbar interbody fusion (LLIF/XLIF) are 2 commonly used approaches. ALIF provides excellent visualization and access to the disc space but is associated with comparatively higher rates of approach-related complications, including injury to the major retroperitoneal vessels, neurological structures, the peritoneum and its contents.2, 3, 4, 5 The LLIF technique aims to circumvent these disadvantages but dissection of the psoas muscle introduces unique postoperative proximal lower limb neurologic deficits.6, 7, 8 The anterior-to-psoas (ATP) or oblique lumbar interbody fusion (OLIF) is the proposed solution to the approach-related disadvantages of ALIF and LLIF by using the anatomic space between the aorta/inferior vena cava (IVC) and psoas muscle to access the disc space.2, 4, 9, 10

The objective of this review is to summarize the technical experiences reported in the literature with the OLIF technique, to determine the operative outcomes achieved thus far and the complications profile in an attempt to elucidate the direction of future research.

Section snippets

Methods

A systematic search of the literature was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.11, 12, 13 Six electronic databases were accessed: Ovid Medline, PubMed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, ACP Journal Club, and Database of Abstracts of Review of Effectiveness. Search terms included MeSH terms and keywords such as “oblique lumbar interbody fusion,” “OLIF,” and “anterior to

Results

A total of 157 studies were identified using the described methodology. A title and abstract screen excluded 128 duplicate or irrelevant studies, leaving 29 articles for review of the full text. After a detailed screen of the full text, 16 articles were selected for appraisal and inclusion in this review.4, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29 The selection process is summarized in Figure 1 and the characteristics of the selected clinical studies are presented in Table 1.

Rationale for the OLIF Technique

Spinal fusion techniques have continuously evolved and new approaches have developed in response to the unique advantages and disadvantages that each surgical method entails. ALIF and LLIF are 2 widely used approaches to access the lumbar spine.

The ALIF approach is advantageous for the lower lumbar levels including L4-L5 and L5-S1, because the bifurcation of the iliac vessels provides a broad and easy exposure of the intervertebral disc such that discectomy can be performed efficiently, larger

Conclusions

Given the early results and experiences by various groups, the OLIF approach represents a viable option in the spinal surgeons' arsenal of spinal fusion techniques. The theoretical advantages of OLIF over ALIF and LLIF approaches to the L1-L5 levels are apparent and warrant further investigation. Larger randomized controlled trials with long-term follow-up should be conducted to draw more definitive conclusions regarding advantages in avoiding vascular and neurological complications compared

References (37)

  • R. Hartl et al.

    Comparison of the safety outcomes between two surgical approaches for anterior lumbar fusion surgery: anterior lumbar interbody fusion (ALIF) and extreme lateral interbody fusion (ELIF)

    Eur Spine J

    (2016)
  • M.D. Cummock et al.

    An analysis of postoperative thigh symptoms after minimally invasive transpsoas lumbar interbody fusion: clinical article

    J Neurosurg Spine

    (2011)
  • T.T. Davis et al.

    Lumbar plexus anatomy within the psoas muscle: implications for the transpsoas lateral approach to the L4-L5 disc

    J Bone Joint Surg Am

    (2011)
  • I.D. Gammal et al.

    Systematic review of thigh symptoms after lateral transpsoas interbody fusion for adult patients with degenerative lumbar spine disease

    Int J Spine Surg

    (2015)
  • D.M. Molinares et al.

    Retroperitoneal oblique corridor to the L2-S1 intervertebral discs: an MRI study

    J Neurosurg Spine

    (2016)
  • A. Liberati et al.

    The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration

    BMJ

    (2009)
  • D. Moher et al.

    Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

    PLoS Med

    (2009)
  • K. Phan et al.

    Systematic reviews and meta-analyses in spine surgery, neurosurgery and orthopedics: guidelines for the surgeon scientist

    J Spine Surg

    (2015)
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    Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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