Introduction: Trans psoas lateral interbody procedures have introduced a new set of complications to spine surgery that were not present with posterior approaches. The oblique lateral interbody technique accesses the disc space just anterior to the psoas muscle, and avoids many of the complications associated with this approach. While this is still a retroperitoneal approach, staying anterior to the psoas muscle has eliminated the risks of the trans psoas approach. This is a discussion of our early initial experience with the oblique lateral interbody technique, as it relates to psoas complications that can occur with the trans psoas technique.
Methods: This is a retrospective review of 25 patients, in whom we have performed this procedure, ranging from a single level to four level procedures. Office charts were reviewed looking for specific complications that would be associated with irritation to the psoas muscle and the lumbar plexus that runs through it. We have not seen iliopsoas dysfunction related to the approach. EMG monitoring was performed during these operations.
Results: There has been two cases with ileus, neither of which required a nasogastric tube. The patients' stay was prolonged 3 and 4 days respectively but the ileus resolved spontaneously. No gross motor deficit or anterior thigh pain or numbness was identified in any of these patients.
Conclusions: An oblique lateral interbody approach still carries the risk of retroperitoneal surgery, but without the risks of iliopsoas dysfunction as related to the the trans psoas approach. The other benefit of this approach is that there is access from L2 down to the sacrum from the same lateral decubitus position. The limitations at L4-5 and L5-S1 present with lateral trans psoas surgery, are not present with an oblique approach. While the limited number of levels and patients presented here may not reach statistical significance,this is a promising early experience with a new technique that may help reduce complications with trans psoas surgery.
Patient Care: This procedure has the potential to reduce approach related morbidity to the lateral lumbar spine by staying out of the psoas muscle.
Learning Objectives: By the conclusion of this session, the participants should be able to: 1.) Distinguish the difference between a LLIF and OLIF 2.)Understand the complications associated with a retroperitoneal approach. 3.) Understand the complications associated with a trans psoas approach 4.) Be able to decide where the skin incision and retractor would be placed for a successful procedure to be performed.