Lumbar Spinal Fusion Using Lateral Oblique (Pre-psoas) Approach (Review)

Abstract

Lumbar spinal fusion is one of the most common operations in spinal surgery. For its implementation, anterolateral (pre-psoas) approach (oblique lumbar interbody fusion, OLIF) is now increasingly used due to its high efficacy and safety. However, there is still little information on the clinical and radiological results of using this technique. The aim of the study was to analyze the safety and efficacy of OLIF in the treatment of lumbar spine disorders as presented in the literature. Materials and Methods The systematic electronic search was performed using the Ovid Medline, PubMed, and eLIBRARY.RU electronic databases. The following search key words were used: Oblique Lumbar Interbody Fusion, OLIF, Anterior to Psoas Lumbar Interbody Fusion, and ATP. Results For the final analysis, 17 sources were selected; with a total of 2900 patients. Total complication rate was 13.9% (403 cases). The incidence of severe persistent complications was less than 1%. Based on the data obtained, we compared the clinical and radiological results of OLIF with other lumbar fusion methods. Conclusion OLIF is an effective, versatile, and minimally traumatic option for lumbar fusion with relatively few complications, which makes it superior to other retroperitoneal approaches. However, the OLIF technique is not completely free of complications associated with the ventral approach, and it cannot provide adequate decompression of the spinal canal in all cases. In addition, anterior approach surgery is still of limited use in cases of spinal deformities; adequate correction of deformity is achievable mainly in combination with posterior surgery.

The Evolution of Lateral Lumbar Interbody Fusion: A Journey from Past to Present

“…Some nerve branches supplying the psoas traverse the intervertebral disc obliquely prior to ramification within the muscle and are, therefore, vulnerable to injury when muscle fibers of the superficial layer of psoas are pulled away from vertebral bodies [ 95 , 96 , 97 ]. Nonetheless, since most of the psoas muscle fibers are still preserved in OLIF, it is less associated with hip flexion weakness, with only up to 1.2–13.9% of patients experiencing postoperative hip flexion weakness as compared to 4.9–31.4% in XLIF [ 95 , 96 , 98 , 99 , 100 , 101 , 102 , 103 , 104 ]. As the lumbar plexus is also avoided, there is a reduced likelihood of lower limb sensory and motor weakness following OLIF as compared to XLIF.…”

“…Similar to XLIF, OLIF is known to restore sagittal profiles and satisfies Schwab’s criteria for proper global alignment [ 111 ]. Proper global alignment has been linked to improved quality of life for adult patients with spinal deformities, especially spondylolisthesis [ 104 , 112 , 113 , 114 , 115 , 116 , 117 ]. Ko et al measured the sagittal disc angle (SDA), coronal disc angle (CDA), mean disc height (MDH), and intervertebral foramen height (FH) directly after the XLIF and OLIF surgery, and one year postoperatively.…”

Customized Artificial Implants: Bionic Design and Multiscale Evaluation

“…Fourth, the interbody fusion used in OLIF is much larger compared to conventional posterior fusions, and it is placed across the endplate, which significantly enhances its biomechanical stability. In addition, OLIF has the advantages of a low complication rate, less surgical blood loss, shorter operative time, and shorter patient hospital stay (Mobbs et al, 2015;Aleinik et al, 2021). Joseph et al (2015) reported a complication rate of 20.2% (380/1885) after TLIF, whereas Abe et al ( 2017) reported a complication rate of 1.2% (2/155) after OLIF, indicating a significant reduction in innerve injury with OLIF.…”

Biomechanical stability of oblique lateral interbody fusion combined with four types of internal fixations: finite element analysis

“…Oblique lateral lumbar interbody fusion (OLIF) is considered one of the best options for lumbar fusion ( Aleinik et al, 2021 ). In 1997, Mayer ( Mayer, 1997 ) described a minimally invasive anterior approach to the lumbar spine through a retroperitoneal approach at the L2-L5 level and a transabdominal approach at the L5-S1 level, which first proposed OLIF.…”

“…Fourth, the interbody fusion used in OLIF is much larger compared to conventional posterior fusions, and it is placed across the endplate, which significantly enhances its biomechanical stability. In addition, OLIF has the advantages of a low complication rate, less surgical blood loss, shorter operative time, and shorter patient hospital stay ( Mobbs et al, 2015 ; Lu and Lu, 2019 ; Aleinik et al, 2021 ). Joseph et al (2015) reported a complication rate of 20.2% (380/1885) after TLIF, whereas Abe et al (2017) reported a complication rate of 1.2% (2/155) after OLIF, indicating a significant reduction in innerve injury with OLIF.…”