Pearls and Pitfalls of Oblique Lateral Interbody Fusion: A Comprehensive Narrative Review

Kim, Hyoungmin; Chang, Bong Soon; Chang, Sam Yeol

doi:10.14245/ns.2143236.618

Cited by 38 publications

(35 citation statements)

References 101 publications

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“…Consistent with previous publications, our data showed that ALIF improved disc height, segmental lordosis, and overall lumbar lordosis compared with TLIF, with a concomitant decrease in PI-LL mismatch. [27][28][29][30] Dorward et al 14 found that ALIF provided more segmental lordosis than TLIF, although TLIF provided more scoliosis correction due to the total facetectomy. 10 In addition, Kim et al found that even the mini-open ALIF had better radiographic improvement compared with the mini-open TLIF in the treatment of spondylolisthesis.…”

Section: Radiographic Evaluation Of Lumbosacral Fusionmentioning

confidence: 99%

Comparison of Lumbosacral Fusion Grade in Patients after Transforaminal and Anterior Lumbar Interbody Fusion with Minimum 2‐Year Follow‐Up

Liu

Xie

Chin

et al. 2023

Orthopaedic Surgery

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ObjectiveGenerally, anterior lumbar interbody fusion (ALIF) was believed superior to transforaminal lumbar interbody fusion (TLIF) in induction of fusion. However, many studies have reported comparable results in lumbosacral fusion rate between the two approaches. This study aimed to evaluate the realistic lumbosacral arthrodesis rates following ALIF and TLIF in patients with degenerative spondylolisthesis as measured by CT and radiology.MethodsNinety‐six patients who underwent single‐level L5‐S1 fusion through ALIF (n = 48) or TLIF (n = 48) for degenerative spondylolisthesis at the Spine Center, University of California San Francisco, between October 2014 and December 2017 were retrospectively evaluated. Fusion was independently evaluated and categorized as solid fusion, indeterminate fusion, or pseudarthroses by two radiologists using the modified Brantigan–Steffee–Fraser (mBSF) grade. Clinical data on sex, age, body mass index, Meyerding grade, smoking status, follow‐up times, complications, and radiological parameters including disc height, disc angle, segmental lordosis, and overall lumbar lordosis were collected. The fusion results and clinical and radiographic data were statistically compared between the ALIF and TLIF groups by using t‐test or chi‐square test.ResultsThe mean follow‐up period was 37.5 (ranging from 24 to 51) months. Clear, solid radiographic fusions were higher in the ALIF group compared with the TLIF group at the last follow‐up (75% vs 47.9%, p = 0.006). Indeterminate fusion occurred in 20.8% (10/48) of ALIF cases and in 43.8% (21/48) of TLIF cases (p = 0.028). Radiographic pseudarthrosis was not significantly different between the TLIF and ALIF groups (16.7% vs 8.3%; p = 0.677). In subgroup analysis of the patients without bone morphogenetic protein (BMP), the solid radiographic fusion rate was significantly higher in the ALIF group than that in the TLIF group (78.6% vs 45.5%; p = 0.037). There were no differences in sex, age, body mass index, Meyerding grade, smoking status, or follow‐up time between the two groups (p > 0.05). The ALIF group had more improvement in disc height (7.8 mm vs 4.7 mm), disc angle (5.2° vs 1.5°), segmental lordosis (7.0° vs 2.5°), and overall lumbar lordosis (4.7° vs 0.7°) compared with the TLIF group (p < 0.05). Overall complication rates were similar between the TLIF and ALIF groups (10.4% vs 8.33%; p > 0.999).ConclusionsWith a minimum 2‐year radiographic analysis of arthrodesis at lumbosacral level by radiologists, the rate of solid radiographic fusions was higher in the ALIF group compared with the TLIF group, whereas the TLIF group had a higher rate of indeterminate fusion. Radiographic pseudarthrosis did not differ significantly between the TLIF and ALIF groups.

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Section: Radiographic Evaluation Of Lumbosacral Fusionmentioning

confidence: 99%

Comparison of Lumbosacral Fusion Grade in Patients after Transforaminal and Anterior Lumbar Interbody Fusion with Minimum 2‐Year Follow‐Up

Liu

Xie

Chin

et al. 2023

Orthopaedic Surgery

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“…[1][2][3][4][5][6][7] Oblique lumbar interbody fusion (OLIF) via a retroperitoneal approach is a minimally invasive surgical technique for lumbar spinal fusion surgery. [8][9][10][11][12][13] Traditionally, attention has been given to clinical and radiological outcomes and well-known complications during the perioperative period. 6,13,14 Currently, a systematic approach toward the care of patients is emphasized to improve patients' overall outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…[8][9][10][11][12][13] Traditionally, attention has been given to clinical and radiological outcomes and well-known complications during the perioperative period. 6,13,14 Currently, a systematic approach toward the care of patients is emphasized to improve patients' overall outcomes. 15 The well-known complications of OLIF include postoperative neurological de cit, vascular injury, ureter injury, bowel injury, and paralytic ileus.…”

Section: Introductionmentioning

confidence: 99%

Postoperative Urinary Retention After Oblique Lumbar Interbody Fusion Under the Systematic Management Protocol

Lim

Khan

Lee

et al. 2023

Preprint

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Oblique lumbar interbody fusion (OLIF) is a minimally invasive lateral lumbar fusion technique and patients are discharged 1–2 days after surgery. Because OLIF utilizes a retroperitoneal approach close to the superior hypogastric plexus, postoperative urinary retention (POUR) may not be an uncommon problem. The purpose of this study was to present the incidence and outcomes of POUR with a systematic care protocol. The records of 102 consecutive patients (M:F = 34:68; mean age, 68.0 ± 8.4 years) were retrospectively reviewed. After OLIF, the indwelling urinary catheter was immediately removed, and every patient was encouraged to void within 6 hours. The POUR care protocol, following a clinical pathway, was based on residual urine (RU), which was monitored with an ultrasound bladder scan after each voiding or every 6 hours for 48 hours. The incidence rate of POUR was 44% (45/102) at 24 hours, 17% (17/102) at 48 hours, and 2% (2/102) at 1 month. Preoperative urological symptoms (odds ratio [OR], 3.6) and violation of the protocol (OR, 28.0) were risk factors at 24 hours. At 48 hours, violation of the protocol was the only risk factor (OR, 10.5). Identifying risk factors and a preemptive care protocol may reduce permanent POUR.

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“…Anterior-to-psoas (ATP) fusion approach uses the natural access corridor between the vasculature and psoas major, termed the safe window (SW). 1-4 Nevertheless, ATP fusion harbors several approach-related risks including urological, neurological, and vascular injury. 5-8 Furthermore, non-neurological and bony structures such as kidneys, ribs, liver, spleen, and iliac crests can also pose access-related difficulties through the SW.…”

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confidence: 99%

Anterior-To-Psoas Approach Measurements, Feasibility, Non-Neurological Structures at Risk and Influencing Factors: A Bilateral Analysis From L1-L5 Using Computed Tomography Imaging

Razzouk

Ramos

Mehta

et al. 2023

Operative Neurosurgery

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BACKGROUND AND OBJECTIVES: Spinal fusion through the anterior-to-psoas (ATP) technique harbors several approach-related risks. We used abdominal computed tomography imaging to analyze the L1-L5 ATP fusion approach measurements, feasibility, degree of obstruction by non-neurological structures, and the influence of patient characteristics on ATP approach dimensions. METHODS: The vascular window, psoas window, safe window, and incision line anterior and posterior margins for the ATP approach were measured on abdominal computed tomography imaging. The feasibility of approach and the presence of kidneys, ribs, liver, spleen, and iliac crests within the ATP approach were also measured. Correlation and regression models among radiographic measurements and patient age, height, weight, and body mass index (BMI) were analyzed as well as differences in approach measurements based on sex. RESULTS: Safe window and incision line measurements were more accommodating for the left-sided vs right-sided ATP approach. At L4-5, the ATP approach was not feasible 18% of the time on the left side vs 60% of the time on the right side. The spleen was present 22%, 10%, and 3% of the time from L1-4, while the liver was present 56%, 30%, and 9% of the time. The iliac crests were not observed within ATP parameters. Patient age, height, weight, and BMI did not strongly correlate with approach measurements, although ATP dimensions did differ based on sex. CONCLUSION: This study reports characteristics of the ATP approach including approach measurements, feasibility, non-neurological structures at risk, and influencing factors to approach measurements. While incision line measurements are larger for male patients compared with female patients at the lower lumbar levels, safe window sizes are similar across all levels L1-L5. The kidneys, ribs, spleen, and liver are potential at-risk structures during the ATP approach, although the iliac crests pose limited concern for ATP technique. Patient characteristics such as age, height, weight, and BMI do not markedly affect ATP approach considerations.

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Pearls and Pitfalls of Oblique Lateral Interbody Fusion: A Comprehensive Narrative Review

Cited by 38 publications

References 101 publications

Comparison of Lumbosacral Fusion Grade in Patients after Transforaminal and Anterior Lumbar Interbody Fusion with Minimum 2‐Year Follow‐Up

Comparison of Lumbosacral Fusion Grade in Patients after Transforaminal and Anterior Lumbar Interbody Fusion with Minimum 2‐Year Follow‐Up

Postoperative Urinary Retention After Oblique Lumbar Interbody Fusion Under the Systematic Management Protocol

Anterior-To-Psoas Approach Measurements, Feasibility, Non-Neurological Structures at Risk and Influencing Factors: A Bilateral Analysis From L1-L5 Using Computed Tomography Imaging

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