Introduction: Minimally Invasive (MI) fusions of the lumbar spine are associated with lower complication rates and improved outcomes relative to their open equivalents, but have not gained widespread acceptance in part because they are technically challenging procedures. Oblique Lateral Lumbar Interbody Fusion (OLLIF) is a new MI fusion of the lumbar spine that is technically straightforward because it does not require direct visualization. In OLLIF the disk space is approached through Kambin’s triangle guided by electrophysiological monitoring and biplanar fluoroscopic imaging. Unlike other MI fusions, OLLIF does not require facetectomy or laminectomy.
Methods: This is a retrospective chart review of perioperative outcomes and technical notes from 292 OLLIF surgeries on 538 levels with a control group of 58 open Transforaminal Lumbar Interbody Fusions (TLIFs) on 153 levels, all performed by the same surgeon. We also collected fusion rates and patient reported outcomes on the oswestry disability index (ODI) one-year post-surgery for the OLLIF group. Kambin's Triangle can easily be located as a silent window with an electrophysiological probe. Discectomy is performed through a single access portal with a 10 mm diameter. After a discectomy, the disc space is packed with beta-tricalcium phosphate soaked in autologous bone marrow, aspirated, and the cage is inserted. Finally, a minimally invasive posterior fixation is performed.
Results: OLLIF cuts surgery times and hospital-stay in half relative to TLIF (59/132min, 4.7/2.3days respectively) and reduces blood loss by over 87% (355/44ml). OLLIF patients report significant improvements on the ODI. OLLIF is a straightforward procedure with a steep learning curve for the surgeon. OLLIF can be adapted to correct spinal deformities like scoliosis and for fusions of the thoracic spine.
Conclusions: OLLIF is a MI fusion of the lumbar spine that is safe, effective and technically less demanding than comparable procedures. OLLIF has the potential to improve clinical outcomes relative to the current standard of care.
Patient Care: OLLIF has the potential to improve clinical outcomes relative to the current standard of care.
Learning Objectives: Oblique lumbar lateral interbody fusion (OLLIF) is a superior technique for fusion of the lumbar spine that overcomes the complications of other MIS procedures. Outcome measures include patient demographics, reported outcomes, and surgical outcomes.
References: 1. Epidemiological features of chronic low back pain. Andersson GB. Lancet. 1999;354:581–585. [PubMed]
2. An overview of the incidences and costs of low back pain. Frymoyer JW, Cats-Baril WL. Orthop Clin North Am. 1991;22:263–271. [PubMed]
3. Estimates and patterns of direct health care expenditures among individuals with back pain in the United States. Luo X, Pietrobon R, Sun SX, Liu GG, Hey L. Spine. 2004;29:79–86. [PubMed]
4. The treatment of ruptured lumbar intervertebral disc by vertebral body fusion. III. Method of use of banked bone. Cloward RB. J Neurosurg. 1953;10:154–168. [PubMed]
5. A one-stage procedure in operative treatment of spondylolisthesis: Dorsal traction-reposition and anterior fusion (author’s translation) (Article in German) Harms J, Rolinger H. Z Orthop Ihre Grenzgeb. 1982;120:343–347. [PubMed]
6. Comparison of low back fusion techniques: transforaminal lumbar interbody fusion (TLIF) or posterior lumbar interbody fusion (PLIF) approaches. Cole CD, McCall TD, Schmidt MH, Dailey AT. Curr Rev Musculoskelet Med. 2009;2:118–126. [PMC free article] [PubMed]
7. Comparison of posterior and transforaminal approaches to lumbar interbody fusion. Humphreys SC, Hodges SD, Patwardhan AG, Eck JC, Murphy RB, Covington LA. Spine. 2001;26:567–571. [PubMed]
8. Local denervation atrophy of paraspinal muscles in postoperative failed back syndrome. Sihvonen T, Herno A, Paljärvi L, Airaksinen O, Partanen J, Tapaninaho A. Spine (Phila Pa 1976) 1993;18:575–581. [PubMed]
9. Minimally-invasive technique for transforaminal lumbar interbody fusion (TLIF) Ozgur BM, Yoo K, Rodriguez G, Taylor WR. Eur Spine J. 2005;14:887–894. [PubMed]
10. Comparative outcomes of minimally invasive surgery for posterior lumbar fusion: a systematic review. Goldstein C, Macwan K. Clin Orthop Relat Res. 2014;472:1727–1737. [PMC free article] [PubMed]
11. Minimally invasive transforaminal lumbar interbody fusion for the treatment of degenerative lumbar diseases. Shunwu F, Xing Z, Fengdong Z, Xiangqian F. Spine (Phila Pa 1976) 2010;35:1615–1620. [PubMed]
12. Effect of minimally invasive technique on return to work and narcotic use following transforaminal lumbar inter-body fusion: a review. Parker SL, Lerner J, McGirt MJ. Prof Case Manag. 2012;17:229–235. [PubMed]
13. Isaacs RE, Fessler RG, Bresnahan L. Atlas of Neurosurgical Techniques Spine and Peripheral Nerves. New York: Thieme Medical Publishers; 2006. Microendoscopically assisted transforaminal lumbar interbody fusion; pp. 859–865.
14. Arthroscopic discectomy of the lumbar spine. Kambin P, Zhou L. Clin Orthop Relat Res. 1997;337:49–57. [PubMed]
15. Posterolateral percutaneous suctionexcision of herniated lumbar intervertebral discs. Report of interim results. Kambin P, Sampson S. Clin Orthop Relat Res. 1986;207:37–43. [PubMed]
16. Kambin’s Triangle approach of lumbar transforaminal epidural injection with spinal stenosis. Park JW, Nam HS, Cho SK, Jung HJ, Lee BJ, Park Y. Ann Rehabil Med. 2011;35:833–843. [PMC free article] [PubMed]
17. Electromyographic monitoring and its anatomical implications in minimally invasive spine surgery. Uribe JS, Vale FL, Dakwar E. Spine (Phila Pa 1976) 2010;35:0–74. [PubMed]
18. Percutaneous pedicle screw fixation of the lumbar spine. Foley KT, Gupta SK, Justis JR, Sherman MC. Neurosurg Focus. 2001;10:0. [PubMed]