Oblique retroperitoneal approach for lumbar interbody fusion from L1 to S1 in adult spinal deformity

Abstract

In recent years, with advancements in surgical techniques and instrumentation, the lateral lumbar interbody fusion is being used increasingly as an alternative procedure to anterior approach. In this study, we illustrated a oblique retroperitoneal approach for lumbar interbody fusion with one incision site and tilting of the operation table in adult spinal deformity and evaluate the radiographical findings and clinical outcomes of patients treated using this technique. This study included 32 patients scheduled to undergo anterior and posterior long-level fusions for lumbar degenerative kyphosis or degenerative lumbar scoliosis. Data collected included blood loss, operative time, incision size, and perioperative complications. Pre- and postoperative radiographic parameters and clinical outcome measures were assessed. Mean follow-up time was 26.1 months. The mean blood losses were 107.4 and 102.4 ml, and the mean operative times were 116, 97, and 82 min for the patients within five levels (4 cases), four levels (18 cases), and three levels (10 cases). The mean incision sizes were 14.63, 13.82, and 12.5 cm in the patients with five, four, and three levels. The mean pelvic incidence was 50.3°. The mean preoperative sagittal vertical axis (SVA) was + 13.66 cm, and the last follow-up SVA was + 2.94 cm. The preoperative lumbar lordosis (LL) was 5.79°, and the last follow-up LL was 46.54°. The mean correction angle was 41°. The mean Cobb angle decreased from a preoperative value of 21.55° to 9.6°at the last follow-up. An oblique retroperitoneal approach is very safe, allowing reproducible access from L1 to S1 for lumbar interbody fusion in adult spinal deformity.

Oblique lumbar interbody fusion at the L5-S1 segment via an approach between the psoas muscle and the great vessels: technique note and case presentations.

“…Recently, a few of clinical studies have demonstrated the technical advantages and favorable outcomes of OLIF therapy for lumbar degenerative diseases, mainly involving the L2-5 segments [2,[5][6][7]. Bearing these bene ts in mind, there has been cautious endeavor for the usage of OLIF at the lumbosacral junction.…”

“…As an alternative technique to lateral lumbar interbody fusion (LLIF), the OLIF procedure has several theoretical advantages over LLIF, such as avoiding psoas muscle disruption and lumbosacral plexus injury, consistent access to the lower lumbar levels without the need for neuromonitoring [3,4]. Recently, OLIF has been generally recognized as an effective procedure in the treatment of various spinal pathologies at L2-L5 segments, including degenerative disc disease, lumbar spondylosis, spondylolisthesis, lumbar stenosis and scoliosis [2,[5][6][7].…”

“…With the advancement in surgical techniques and instruments, several spine surgeons attempt to perform L5-S1 interbody fusion with the OLIF technique (termed as OLIF L5-S1) [2,[6][7][8][9][10][11][12]. The usage of OLIF at the lumbosacral junction can provide larger surface area for solid fusion, reestablish anterior column support, and simultaneously achieve indirect decompression and correction of sagittal alignment.…”

Development and Application of Oblique Lumbar Interbody Fusion

“…According to the scoliosis research society–Schwab classification of adult scoliosis proposed by Schwab, the three revised parameters of the sagittal vertical axis (SVA, cm), pelvic tilt (PT, °), and pelvic incidence‐lumbar lordosis (PI‐LL, °) are considered to be closely related to the quality of life. Some scholars believe that SVA <50 mm, PT <20°, and LL‐PI <10°are attributed to the thresholds of health. They can be used as important references for the surgeon to evaluate the sagittal balance of ADS patients before surgery and to formulate the operation plan.…”

“…Postoperative pain scores improved. Kim et al . performed OLIF on 32 patients with scoliosis deformity.…”