Original ArticleOblique Lumbar Interbody Fusion: Technical Aspects, Operative Outcomes, and Complications
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)
- et al.
Review of early clinical results and complications associated with oblique lumbar interbody fusion (OLIF)
J Clin Neurosci
(2016) - et al.
Intravertebral plate and cage system via lateral trajectory for lumbar interbody fusion-a novel fixation device
Spine J
(2010) - et al.
The mini-open anterolateral approach for degenerative thoracolumbar disease
Clin Neurol Neurosurg
(2010) - et al.
A new extensile anterolateral retroperitoneal approach for lumbar interbody fusion from l1 to s1: a prospective series with clinical outcomes
Spine J
(2016) - et al.
Extreme lateral interbody fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion
Spine J
(2006) - et al.
Two-year clinical and radiographic success of minimally invasive lateral transpsoas approach for the treatment of degenerative lumbar conditions
SAS J
(2010) - et al.
Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 1: introduction and methodology
J Neurosurg Spine
(2014) - et al.
Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF
J Spine Surg
(2015) - et al.
Outcomes of anterior lumbar interbody fusion surgery based on indication: a prospective study
Neurosurgery
(2015) - et al.
Complications and morbidities of mini-open anterior retroperitoneal lumbar interbody fusion: oblique lumbar interbody fusion in 179 patients
Asian Spine J
(2012)
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
An analysis of postoperative thigh symptoms after minimally invasive transpsoas lumbar interbody fusion: clinical article
J Neurosurg Spine
Lumbar plexus anatomy within the psoas muscle: implications for the transpsoas lateral approach to the L4-L5 disc
J Bone Joint Surg Am
Systematic review of thigh symptoms after lateral transpsoas interbody fusion for adult patients with degenerative lumbar spine disease
Int J Spine Surg
Retroperitoneal oblique corridor to the L2-S1 intervertebral discs: an MRI study
J Neurosurg Spine
The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration
BMJ
Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement
PLoS Med
Systematic reviews and meta-analyses in spine surgery, neurosurgery and orthopedics: guidelines for the surgeon scientist
J Spine Surg
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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.