Safety of lateral interbody fusion surgery without intraoperative monitoring

Lee, Hong-Jae; Ryu, Kyeong‐Sik; Hur, Jung‐Woo; Seong, Ji-Hoon; Cho, Hyun Jin; Kim, Jin-Sung

doi:10.5137/1019-5149.jtn.20103-17.1

Cited by 5 publications

(4 citation statements)

References 9 publications

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“…Among these approaches, OLIF/ATP shows the greatest versatility, allowing exposure of nearly all lumbar levels from T12-S1[ 4 ], and provides distinct advantages over other anterior and posterior approaches with favorable complication profiles[ 9 , 10 ]. Neuromonitoring is not considered essential[ 4 , 5 , 18 ] as the psoas muscle cushions the lumbar plexus during retraction. Intraoperative muscle relaxation can be employed with favorable effects on abdominal wall musculature compliance, psoas retractability[ 20 ], and intra-abdominal pressure.…”

Section: Discussionmentioning

confidence: 99%

“…The oblique trajectory avoids the iliac crest and lower ribs, which are impediments to lateral lumbar interbody fusion (LLIF)[ 1 ]. Staying outside the psoas reduces the risk of lumbar plexus injuries[ 2 , 3 ], and allows complete muscle relaxation as neuromonitoring is not considered essential for this approach[ 4 , 5 ]. Moreover, a wide anatomic corridor between the left psoas and aorta allows easy access to all lumbar spinal levels above L5[ 6 ], often without the need for any vascular retraction or ligation[ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Nuances of oblique lumbar interbody fusion at L5-S1: Three case reports

Berry¹

2021

WJO

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BACKGROUND Oblique lumbar interbody fusion is a mini-open retroperitoneal approach that uses a wide corridor between the left psoas muscle and the aorta above L5. This approach avoids the limitations of lateral lumbar interbody fusion, is considered less invasive than anterior lumbar interbody fusion, and is similarly effective for indirect decompression and improving lordosis while maintaining a low complication profile. Including L5-S1, when required, adds to these advantages, as this allows single-position surgery. However, variations in vascular anatomy can affect the ease of access to the L5-S1 disc. The nuances of three different oblique anterolateral techniques to access L5-S1 for interbody fusion, namely, left-sided intra-bifurcation, left-sided pre-psoas, and right-sided pre-psoas approaches, are illustrated using three representative case studies. CASE SUMMARY Cases of three patients who underwent multilevel oblique lumbar interbody fusion including L5-S1, using one of the three different techniques, are described. All patients presented with symptomatic degenerative lumbar pathology and failed conservative management prior to surgery. The anatomical considerations that affected the decisions to utilize each approach are discussed. The pros and cons of each approach are also discussed. A parasagittal facet line objectively assesses the relationship between the left common iliac vein and the L5-S1 disc and assists in choosing the approach to L5-S1. CONCLUSION Oblique retroperitoneal access to L5-S1 in the lateral decubitus position is possible through three different approaches. The choice of approach to L5-S1 may be individualized based on a patient’s vascular anatomy using preoperative imaging. While most surgeons will rely on their experience and comfort level in choosing the approach, this article elucidates the nuances of each technique.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Nuances of oblique lumbar interbody fusion at L5-S1: Three case reports

Berry¹

2021

WJO

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“…Oblique lumbar interbody fusion (OLIF) is becoming increasingly prevalent in treating lumbar spinal degenerative diseases due to its minimal invasiveness, indirect decompression, high fusion rate, and ability to allow fast rehabilitation (1,2). Compared to traditional transforaminal lumbar interbody fusion (TLIF), the OLIF procedure has many advantages.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical study of two-level oblique lumbar interbody fusion with different types of lateral instrumentation: a finite element analysis

Zhong,

Wang,

Zhou

et al. 2023

Front. Med.

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ObjectiveThe aim of this study was to verify the biomechanical properties of a newly designed angulated lateral plate (mini-LP) suited for two-level oblique lumbar interbody fusion (OLIF). The mini-LP is placed through the lateral ante-psoas surgical corridor, which reduces the operative time and complications associated with prolonged anesthesia and placement in the prone position.MethodsA three-dimensional nonlinear finite element (FE) model of an intact L1–L5 lumbar spine was constructed and validated. The intact model was modified to generate a two-level OLIF surgery model augmented with three types of lateral fixation (stand-alone, SA; lateral rod screw, LRS; miniature lateral plate, mini-LP); the operative segments were L2–L3 and L3–L4. By applying a 500 N follower load and 7.5 Nm directional moment (flexion-extension, lateral bending, and axial rotation), all models were used to simulate human spine movement. Then, we extracted the range of motion (ROM), peak contact force of the bony endplate (PCFBE), peak equivalent stress of the cage (PESC), peak equivalent stress of fixation (PESF), and stress contour plots.ResultsWhen compared with the intact model, the SA model achieved the least reduction in ROM to surgical segments in all motions. The ROM of the mini-LP model was slightly smaller than that of the LRS model. There were no significant differences in surgical segments (L1–L2, L4–L5) between all surgical models and the intact model. The PCFBE and PESC of the LRS and the mini-LP fixation models were lower than those of the SA model. However, the differences in PCFBE or PESC between the LRS- and mini-LP-based models were not significant. The fixation stress of the LRS- and mini-LP-based models was significantly lower than the yield strength under all loading conditions. In addition, the variances in the PESF in the LRS- and mini-LP-based models were not obvious.ConclusionOur biomechanical FE analysis indicated that LRS or mini-LP fixation can both provide adequate biomechanical stability for two-level OLIF through a single incision. The newly designed mini-LP model seemed to be superior in installation convenience, and equally good outcomes were achieved with both LRS and mini-LP for two-level OLIF.

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“…1,10 The OLIF approach is also referred to by some authors as the anterior to psoas (ATP) approach. 11 The benefits of this approach are thought to be lower risk to the lumbar plexus, the ability to forego neuromonitoring given that the approach is carried out ventral to the lumbar plexus, 12 and the ability to approach ventrally to the iliac crest, which can often obstruct access to the L4-L5 disc space. 13 The OLIF approach also allows access to the L5-S1 disc space via a lateral position, 14 decreasing the number of position changes during surgery.…”

mentioning

confidence: 99%