Background context: Lower back pain is one of the most prevalent and expensive health conditions in the Western world. The standard treatment, interbody fusion, is an invasive procedure that requires the stripping of muscles and soft tissue, leading to surgical morbidity. Current minimally invasive (MI) spinal fusions are technically demanding and suffer from technical limitations.Purpose: Oblique lumbar lateral interbody fusion (OLLIF) is a new technique for fusion of the lumbar spine that overcomes these complications. Outcome measures include patient demographics, reported outcomes, and surgical outcomes.Study design/Setting: Kambin's Triangle can easily be located as a silent window with an electrophysiological probe. Discectomy is performed through a single access portal with a 10 mm diameter. After a discectomy, the disc space is packed with beta-tricalcium phosphate soaked in autologous bone marrow, aspirated, and the cage is inserted. Finally, a minimally invasive posterior fixation is performed.Methods: OLLIF’s major innovation is to approach the disc through Kambin’s Triangle, aided by bilateral fluoroscopy.Results: We present data from 69 consecutive OLLIF surgeries on 128 levels with a control group of 55 consecutive open transformational lumbar interbody fusions (TLIFs) on 125 levels. For a single level OLLIF, the mean surgery time is 69 minutes (min) and blood loss is 29 ml. Surgery time was approximately twice as fast as open TLIF (mean: 135 min) and blood loss is reduced by over 80% compared to TLIF (mean: 355 ml).Conclusions: OLLIF is a minimally invasive fusion that significantly reduces surgery times compared to open surgery. OLLIF overcomes the difficulties of traditional open fusions, making it a safe and technically less demanding surgery than open or minimally invasive TLIF.

BackgroundDegenerative deformities of the spine have traditionally been treated with extensive open surgeries. However, these open procedures are associated with a high degree of surgical morbidity. In this study, we explore whether clinical improvement in patients with spinal deformities can be achieved using a new minimally invasive surgery (MIS) called oblique lateral lumbar interbody fusion (OLLIF). OLLIF is a MIS single surgeon procedure in which the disc is approached through Kambin’s triangle. OLLIF can achieve correction of spinal deformities through careful cage placement.PurposeThe purpose of this study is to establish the safety and efficacy of using OLLIF to correct spinal deformities and to collect early outcome data. Collected data includes perioperative outcomes, patient reported outcomes, and radiographic outcomes.Study design/settingThis study is a retrospective review of 37 OLLIF surgeries in 36 patients with symptomatic degenerative spinal deformity. Collected perioperative data included surgery time, blood loss, and hospital stay. Follow-up was conducted at least 150 days post surgery. We recorded complications and patient reported outcomes such as Oswestry Disability Index (ODI) and pain scale. Imaging was conducted pre- and post-surgery. Fusion rates and changes in Cobb angle were also measured.ResultsA total of 37 surgeries that treated 100 vertebral levels were performed. For two and three level procedures, respectively, the mean blood loss was 83 and 178 ml, the average surgery time was 74 and 158 minutes and the average hospital stay was 2.6 and 3.3 days. The patients ambulated within 24 hours in all but two cases. The patients reported pain improvements on the ten-point pain scale from 8.3 to 3.7 (p<0.001) and on the ODI from 53% to 32%. Cobb angles decreased from 16° to 9.3° (p<0.001), amounting to 2.5° of correction per level of surgery. Detailed imaging was reviewed by independent radiologists for 24 cases and 100% interbody fusion was achieved along with 71% right posterolateral and 74% left posterolateral fusion. There were three cases of mild nerve irritation/neuropraxia and no infections.ConclusionsOLLIF is a safe and effective MIS technique to correct adult degenerative scoliosis. Unlike alternative procedures, OLLIF is technically less complex than comparable procedures and can safely be used from the thoracolumbar junction to S1.

Introduction:Although opioid prescribing has decreased since 2010, overdose deaths involving illicit opioids have continued to rise. This study explores prescribing patterns prior to fatal overdose of decedents who died of prescription and illicit opioid overdoses.Methods: This retrospective cohort study was conducted in 2019 and included all 1,893 Illinois residents who died of an opioid-related overdose in 2016. Each decedent was linked to any existing Prescription Monitoring Program records, calculating weekly morphine milligram equivalents for 52 weeks prior to overdose.Results: Among the 1,893 fatal opioid overdoses, 309 involved any prescription opioid and 1,461 involved illicit opioids without the involvement of prescription opioids. The death rate due to illicit opioids was 23/100,000 among black residents versus 10.5/100,000 among whites. During the last year of life, 76% of prescription opioid decedents filled any opioid prescription totaling 10.7 prescriptions per decedent, compared with 36% of illicit opioid decedents totaling 2.6 prescriptions per decedent. During the last week of life, 33% of prescription opioid decedents filled an opioid prescription totaling 0.42 prescriptions per decedent, compared with 4% of illicit opioid decedents totaling 0.05 prescriptions per decedent.Conclusions: Prescribing patterns alone may not be sufficient to identify patients who are at high risk for opioid overdose, especially for those using illicit opioids. Interventions aimed at reducing opioid overdoses should take into account different patterns of opioid prescribing

Oblique lateral lumbar interbody fusion (OLLIF) is a novel operation for fusions of the lumbar spine from T12–S1. In OLLIF, the disk is approached from an oblique lateral angle guided by electrophysiological monitoring and biplanar fluoroscopy; the disk space is accessed through Kambin’s triangle. We present perioperative, clinical, patient-reported and radiological outcomes from a series of 303 OLLIF procedures on 568 levels performed by the same surgeon. For a single-level OLLIF, mean surgery time was 56.6 ± 37.7 minutes, with a blood loss of 42.2 ± 31.1 mL, fluoroscopy time of 198.8 ± 87.2 seconds and a hospital stay of 2.2 ± 1.7 days. At the one-year follow-up, 10-point pain scale scores improved from 8.6 ± 1.3 to 4.1 ± 3.0 (p < 0.001). Total Oswestry disability index score improved from 56.6% ± 15.3% to 38.6% ± 21.4% (p < 0.001). At the one-year follow-up, 15 (5%) patients had mild nerve root irritation defined as sensory symptoms and motor weakness better than 4/5. Only one patient had neuropraxia due to weakness (3/5). There was one case (0.3%) of superficial wound infection and one case of bleeding into the psoas major. Reoperation within one year was performed for 14 (4.7%) patients. Interbody fusion was achieved in 98.7% of levels. While OLLIF has previously been described, this study is the first to present clinical, patient-reported, and radiological outcomes of OLLIF. Review of the literature shows that OLLIF produces perioperative outcomes, complication rates, and fusion rates that compare favorably with similar procedures. We establish that OLLIF is a safe, efficient and efficacious procedure for fusions of the lumbar spine.

staff was significantly different, with a notable increase between the second and third quarter (first quarter, 173 [24.2%]; second quarter, 148 [20.7%]; third quarter, 205 [28.7%]; fourth quarter, 189 [26.4%[; total, 715 injuries; P = .02). The third quarter corresponds to the first 3 months of residency training, from July to September. The annual NSI incidence rate did not significantly change among house staff from July 2012 to July 2019. Discussion |We report what is, to our knowledge, the largest non-survey-based study of NSI events among house staff. We build on prior studies, which suggest that NSIs occur most often during the first 6 months of training, 4 and further characterize this risk to be highest in the first 3 months of the academic year, with the transition from June to July representing a pivotal point for intervention. Our data suggest that there is a learning curve over which house staff acquire procedural skills, since July coincides with the onboarding of new resident physicians. This trend is unique to house staff in training, in that NSI frequency among nonhouse staff remained stable during the same period.Postgraduate year information was not captured in our data set. Attributing the NSI risk to first-year residents may not explain the entirety of the observed increase, in that non-first-year residents may have new responsibilities resulting in increased fatigue, anxiety, or longer hours, leading to more injuries. 6 Our findings suggest that preventive and educational strategies should target residents during onboarding and potentially be repeated annually between postgraduate years.