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.

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.

Inadvertent injury to the tail of the pancreas is a potentially serious but preventable complication that can occur during laparoscopic splenectomy. The aim of this study was to determine the feasibility of using computed tomography to map the location of the tail of the pancreas relative to the spleen to locate a possible safe zone for splenic hilar dissection and/or hemostasis. Abdominal computed tomography scans of 150 patients were studied. The distance from the tail of the pancreas to the hilum of the spleen was determined for each patient. Resultant descriptive statistics were correlated with patient's age, gender, body mass index, and spleen size using the independent t test, Pearson's correlation coefficient, and multivariate analysis. Computed tomography was successful in mapping the distance from the tail of the pancreas to the splenic hilum in 148 patients. The average distance from the tail of the pancreas to the splenic hilum was 3.42 cm ± 1.54 cm (95% confidence interval, 3.17–3.67). During splenic vascular control, it is important to stay within 1 cm from the splenic hilum to minimize the risk of injury to the tail of the pancreas during splenectomy.

FIG. 1. Coronal CT scan of thorax showing bilateral bullous disease and a lesion in right upper lobe (L ‫ס‬ tumor, B ‫ס‬ bulla).