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Park KH, Chung HW, Lee HD, Jeon CH, Koh JH, Chung NS. Cage Obliquity and Radiological Outcomes in Oblique Lateral Interbody Fusion. Spine (Phila Pa 1976) 2023; 48:1611-1616. [PMID: 36255377 DOI: 10.1097/brs.0000000000004507] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/27/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective radiological study. OBJECTIVE This study aimed to examine whether cage obliquity affects radiological outcomes in oblique lateral interbody fusion (OLIF). SUMMARY OF BACKGROUND DATA The OLIF cage enters the disk space in the oblique direction and is then turned to the true orthogonal orientation. However, orthogonal cage placement is often hindered by cage rotation limitations. Few studies have examined the degree of cage obliquity and its effects in OLIF. MATERIALS AND METHODS This study involved 171 levels in 118 consecutive patients who underwent OLIF between L2-L3 and L4-L5 with a minimum two-year follow-up. Cage obliquity was divided into three groups on postoperative axial computed tomography images; cage obliquity <10° (group 1), cage obliquity ≥10° and <20° (group 2), and cage obliquity ≥20° (group 3). The radiological outcomes included anterior/posterior disk height, intervertebral disk angle, foraminal height, fusion, and cage subsidence. Postoperative complications related to cage obliquity were examined. RESULTS The mean cage obliquity of the 171 cages was 11.3±6.9°. Cage obliquity was greater at the L4-L5 level (13.4±6.4°) than at other levels (L2-L3 and L3-L4: 6.5±7.0° and 10.1±6.2°, respectively) ( P <0.05). There were no significant differences in radiological outcomes among the groups. There were two cases of postoperative contralateral neurological symptoms in group 3. CONCLUSIONS Our study showed that the orthogonal cage rotation in OLIF achieved adequate lateral cage placement. Although accurate cage rotation can be limited at the lower lumbar segments, radiological outcomes were not affected by cage obliquity.
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Affiliation(s)
- Ki-Hoon Park
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, Geyounggi-do Province, South Korea
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Cawley D, Shafafy R, Agu O, Molloy S. Anterior spinal fusion (ALIF/OLIF/LLIF) with lumbosacral transitional vertebra: A systematic review and proposed treatment algorithm. BRAIN & SPINE 2023; 3:101713. [PMID: 38021000 PMCID: PMC10668067 DOI: 10.1016/j.bas.2023.101713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/28/2022] [Accepted: 01/16/2023] [Indexed: 12/01/2023]
Abstract
•Key anterior approaches differences in LSTV include vascular (aortic bifurcation/iliocaval confluence), muscular (psoas) and osseus anatomy (inter-crestal tangent/pubic symphysis), when compared to non-LSTV.•There are increased surgical deviations but not significantly greater complications for anterior approaches in LSTV.•Vascular awareness while accessing L45 will be in the presence of a more cephalad ABF and ICC with sacralized L5, and access to the deeper L56 level will be in the presence of a more caudal ABF and ICC in lumbarized S1.
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Affiliation(s)
- D.T. Cawley
- Mater Private Hospital, Dublin, Republic of Ireland
- National University of Ireland, Galway, Republic of Ireland
| | - R. Shafafy
- Dept of Spinal Surgery, RNOH Stanmore, Brockley Hill, Stanmore, HA7 4LP, UK
| | - O. Agu
- Dept of Spinal Surgery, RNOH Stanmore, Brockley Hill, Stanmore, HA7 4LP, UK
| | - S. Molloy
- Dept of Spinal Surgery, RNOH Stanmore, Brockley Hill, Stanmore, HA7 4LP, UK
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Huang S, Min S, Wang S, Jin A. Biomechanical effects of an oblique lumbar interbody fusion combined with posterior augmentation: a finite element analysis. BMC Musculoskelet Disord 2022; 23:611. [PMID: 35761228 PMCID: PMC9235194 DOI: 10.1186/s12891-022-05553-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 06/06/2022] [Indexed: 11/18/2022] Open
Abstract
Background Oblique lateral interbody fusion (OLIF) is widely used to treat lumbar degenerative disc disease. This study aimed to evaluate the biomechanical stability of OLIF, OLIF including posterior pedicle screw and rod (PSR), and OLIF including cortical screw and rod (CSR) instrumentation through finite element analysis. Methods A complete L2-L5 finite element model of the lumbar spine was constructed. Surgical models of OLIF, such as stand-alone, OLIF combined with PSR, and OLIF combined with CSR were created in the L3-L4 surgical segments. Range of motion (ROM), end plate stress, and internal fixation peak stress were compared between different models under the same loading conditions. Results Compared to the intact model, ROM was reduced in the OLIF model under all loading conditions. The surgical models in order of increasing ROM were PSR, CSR, and stand-alone; however, the difference in ROM between BPS and CSR was less than 0.4° and was not significant under any loading conditions. The stand-alone model had the highest stress on the superior L4 vertebral body endplate under all loading conditions, whereas the end plate stress was relatively low in the BPS and CSR models. The CSR model had the highest internal fixation stress, concentrated primarily at the end of the screw. Conclusions OLIF alone significantly reduces ROM but does not provide sufficient stability. Addition of posterior PSR or CSR internal fixation instrumentation to OLIF surgery can significantly improve biomechanical stability of the segment undergoing surgery.
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Oh BK, Son DW, Lee SH, Lee JS, Sung SK, Lee SW, Song GS. Learning Curve and Complications Experience of Oblique Lateral Interbody Fusion : A Single-Center 143 Consecutive Cases. J Korean Neurosurg Soc 2021; 64:447-459. [PMID: 33993691 PMCID: PMC8128525 DOI: 10.3340/jkns.2020.0342] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 01/13/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Oblique lateral interbody fusion (OLIF) is becoming the preferred treatment for degenerative lumbar diseases. As beginners, we performed 143 surgeries over 19 months. In these consecutive cases, we analyzed the learning curve and reviewed the complications in our experience. METHODS This was a retrospective study; however, complications that were well known in the previous literature were strictly recorded prospectively. We followed up the changes in estimated blood loss (EBL), operation time, and transient psoas paresis according to case accumulation to analyze the learning curve. RESULTS Complication-free patients accounted for 43.6% (12.9%, early stage 70 patients and 74.3%, late stage 70 patients). The most common complication was transient psoas paresis (n=52). Most of these complications occurred in the early stages of learning. C-reactive protein normalization was delayed in seven patients (4.89%). The operation time showed a decreasing trend with the cases; however, EBL did not show any significant change. Notable operation-induced complications were cage malposition, vertebral body fracture, injury to the ureter, and injury to the lumbar vein. CONCLUSION According to the learning curve, the operation time and psoas paresis decreased. It is important to select an appropriately sized cage along with clear dissection of the anterior border of the psoas muscle to prevent OLIF-specific complications.
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Affiliation(s)
- Bu Kwang Oh
- Department of Neurosurgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dong Wuk Son
- Department of Neurosurgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Deparment of Neurosurgery, School of Medicine, Pusan National University, Yangsan, Korea
| | - Su Hun Lee
- Department of Neurosurgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jun Seok Lee
- Department of Neurosurgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Soon Ki Sung
- Department of Neurosurgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Deparment of Neurosurgery, School of Medicine, Pusan National University, Yangsan, Korea
| | - Sang Weon Lee
- Department of Neurosurgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Deparment of Neurosurgery, School of Medicine, Pusan National University, Yangsan, Korea
| | - Geun Sung Song
- Department of Neurosurgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Deparment of Neurosurgery, School of Medicine, Pusan National University, Yangsan, Korea
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Song C, Chang H, Zhang D, Zhang Y, Shi M, Meng X. Biomechanical Evaluation of Oblique Lumbar Interbody Fusion with Various Fixation Options: A Finite Element Analysis. Orthop Surg 2021; 13:517-529. [PMID: 33619850 PMCID: PMC7957407 DOI: 10.1111/os.12877] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/23/2020] [Accepted: 10/26/2020] [Indexed: 01/25/2023] Open
Abstract
Objective The aim of the present study was to clarify the biomechanical properties of oblique lumbar interbody fusion (OLIF) using different fixation methods in normal and osteoporosis spines. Methods Normal and osteoporosis intact finite element models of L1–S1 were established based on CT images of a healthy male volunteer. Group A was the normal models and group B was the osteoporosis model. Each group included four subgroups: (i) intact; (ii) stand‐alone cage (Cage); (iii) cage with lateral plate and two lateral screws (LP); and (iv) cage with bilateral pedicle screws and rods (BPSR). The L3–L4 level was defined as the surgical segment. After validating the normal intact model, compressive load of 400 N and torsional moment of 10 Nm were applied to the superior surface of L2 to simulate flexion, extension, left bending, right bending, left rotation, and right rotation motions. Surgical segmental range of motion (ROM), cage stress, endplate stress, supplemental fixation stress, and stress distribution were analyzed in each group. Results Cage provided the minimal reduction of ROM among all motions (normal, 82.30%–98.81%; osteoporosis, 92.04%–97.29% of intact model). BPSR demonstrated the maximum reduction of ROM (normal, 43.94%–61.13%; osteoporosis, 45.61%–62.27% of intact model). The ROM of LP was between that of Cage and BPSR (normal, 63.25%–79.72%; osteoporosis, 70%–87.15% of intact model). Cage had the minimal cage stress and endplate stress. With the help of LP and BPSR fixation, cage stress and endplate stress were significantly reduced in all motions, both in normal and osteoporosis finite element models. However, BPSR had more advantages. For cage stress, BPSR was at least 75.73% less than that of Cage in the normal model, and it was at least 80.10% less than that of Cage in the osteoporosis model. For endplate stress, BPSR was at least 75.98% less than that of Cage in the normal model, and it was at least 78.06% less than that of Cage in the osteoporosis model. For supplemental fixation stress, BPSR and LP were much less than the yield strength in all motions in the two groups. In addition, the comparison between the two groups showed that the ROM, cage stress, endplate stress, and supplemental fixation stress in the normal model were less than in the osteoporosis model when using the same fixation option of OLIF. Conclusion Oblique lumbar interbody fusion with BPSR provided the best biomechanical stability both in normal and osteoporosis spines. The biomechanical properties of the normal spine were better than those of the osteoporosis spine when using the same fixation option of OLIF.
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Affiliation(s)
- Chengjie Song
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, ShiJiazhuang, China
| | - Hengrui Chang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, ShiJiazhuang, China
| | - Di Zhang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, ShiJiazhuang, China
| | - Yingze Zhang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, ShiJiazhuang, China
| | - Mingxin Shi
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, ShiJiazhuang, China
| | - Xianzhong Meng
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, ShiJiazhuang, China
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Hah R, Kang HP. Lateral and Oblique Lumbar Interbody Fusion-Current Concepts and a Review of Recent Literature. Curr Rev Musculoskelet Med 2019; 12:305-310. [PMID: 31230190 PMCID: PMC6684701 DOI: 10.1007/s12178-019-09562-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To review the relevant recent literature regarding minimally invasive, lateral, and oblique approaches to the anterior lumbar spine, with a particular focus on the operative and postoperative complications. METHODS A literature search was performed on Pubmed and Web of Science using combinations of the following keywords and their acronyms: lateral lumbar interbody fusion (LLIF), oblique lateral interbody fusion (OLIF), anterior-to-psoas approach (ATP), direct lateral interbody fusion (DLIF), extreme lateral interbody fusion (XLIF), and minimally invasive surgery (MIS). All results from January 2016 through January 2019 were evaluated and all studies evaluating complications and/or outcomes were included in the review. RECENT FINDINGS Transient neurological deficit, particularly sensorimotor symptoms of the ipsilateral thigh, remains the most common complication seen in LLIF. Best available current literature demonstrates that approximately 30-40% of patients have postoperative deficits, primarily of the proximal leg. Permanent symptoms are less common, affecting 4-5% of cases. Newer techniques to reduce this rate include different retractors, direct visualization of the nerves, and intraoperative neuromonitoring. OLIF may have lower deficit rates, but the available literature is limited. Subsidence rates in both LLIF and OLIF are comparable to ALIF (anterior lumbar interbody fusion), but further study is required. Supplemental posterior fixation is an active area of investigation that shows favorable biomechanical results, but additional clinical studies are needed. Minimally invasive lumbar interbody fusion techniques continue to advance rapidly. As these techniques continue to mature, evidence-based risk-stratification systems are required to better guide both the patient and clinician in the joint decision-making process for the optimal surgical approach.
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Affiliation(s)
- Raymond Hah
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo Street, Suite 5400, Los Angeles, CA 90033 USA
| | - H. Paco Kang
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo Street, Suite 5400, Los Angeles, CA 90033 USA
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Cheng C, Wang K, Zhang C, Wu H, Jian FZ. Spondylolisthesis with Uncommon Congenital Deformity of L4-L5 Vertebral Fusion Treated by Oblique Lumbar Interbody Fusion. World Neurosurg 2019; 127:222-226. [PMID: 30974268 DOI: 10.1016/j.wneu.2019.04.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Diagnosis and management of congenital anomalies of the spine can be a challenge because of their complex presentations. We present an uncommon case of congenital deformity of the spine with L4-L5 vertebral fusion, mimicking a single vertebra, and L3 spondylolisthesis treated by oblique lumbar interbody fusion (OLIF). CASE DESCRIPTION A 69-year-old woman presented with increasing lower back pain radiating to the left leg, with aggravation of symptoms for the past 6 months, causing difficulty in walking. She also complained of paresthesia along the L3-L5 dermatomes in both legs, with more prominence on the left side. Imaging revealed fusion deformity of the L4-L5 vertebrae, as well as degenerative spondylolisthesis at the L3-L4 level. After treatment with OLIF, the patient had an uneventful recovery period. Comparisons were made between the preoperative and 6-month follow-up visual analog scale and the Oswestry Disability Index scores. The patient showed significant improvement in the scores, as well as in her symptoms. CONCLUSIONS OLIF is a promising technique that can be applied in the management of degenerative disk diseases and also for deformities that may be formidable to treat by adopting the traditional posterior approach.
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Affiliation(s)
- Cheng Cheng
- Department of Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, China; Department of Neurosurgery, Third Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Kai Wang
- Department of Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Can Zhang
- Department of Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Hao Wu
- Department of Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Feng-Zeng Jian
- Department of Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, China.
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