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C-arm-free oblique lumbar interbody fusion at the L5-S1 level (OLIF51) and simultaneous pedicle screw fixation are performed in a lateral position under navigation guidance. This technique does not expose the surgeon or operating staff to radiation hazards.
Oblique lumbar interbody fusion (OLIF) is an established technique for the indirect decompression of lumbar canal stenosis. However, OLIF at the L5-S1 level (OLIF51) is technically difficult because of the anatomical structures. We present a novel simultaneous technique of OLIF51 with percutaneous pedicle screw fixation without fluoroscopy. The patient is placed in a right lateral decubitus position. A percutaneous reference pin is inserted into the right sacroiliac joint. An O-arm scan is performed, and 3D reconstructed images are transmitted to the spinal navigation system. A 4 cm oblique skin incision is made under navigation guidance along the pelvis. The internal/external and transverse abdominal muscles are divided along the muscle fibers, protecting the iliohypogastric and ilioinguinal nerves. Using a retroperitoneal approach, the left common iliac vessels are identified. Special muscle retractors with illumination are used to expose the L5-S1 intervertebral disc. After disc preparation with navigated instruments, the disc space is distracted with navigated trials. Autogenous bone and demineralized bone material are then inserted into the cage hole. The OLIF51 cage is inserted into the disc space with the help of a mallet. Simultaneously, percutaneous pedicle screws are inserted by another surgeon without changing the lateral decubitus position of the patient.
In conclusion, C-arm-free OLIF51 and simultaneous percutaneous pedicle screw fixation are performed in a lateral position under navigation guidance. This novel technique reduces surgical time and radiation hazards.
Spondylosis is regarded as a stress fracture1 and occurs in about 5% of the young adult population2. The most common level of occurrence is at the L5 level due to the unique shearing force applied at the L5-S1 area. The main symptoms of spondylosis and spondylolisthesis are low back pain, leg pain, and numbness. If conservative treatment proves ineffective, surgical treatment is recommended3. Transforaminal lumbar interbody fusion (TLIF) is an effective and established technique4, but the nonunion rate of this procedure is relatively higher at the L5-S1 level
This study was approved by the ethics committee at Okayama Rosai Hospital (No. 201-3).
1. Patient examination
Fourteen cases (average age: 71.5 years) were treated using this new technique. They were compared to 40 cases (average age: 74.0 years) of L5-S1 TLIF. L5-S1 lordosis angle and disc height were measured in both groups. The OLIF51 group obtained a better L5-S1 lordosis than the TLIF 51 group (Figure 15).
Recently, the lateral lumbar approach for interbody fusion has been gaining popularity due to its minimal invasiveness9. Among these approaches, the direct lateral psoas splitting approach has several disadvantages, such as lumbar nerve plexus injury and psoas muscle weakness10. To reduce these complications, prepsoas or OLIF was introduced by Davis et al. in 201411. However, it is difficult to operate at the L5-S1 disc due to its anatomical features.......
This study was supported by the Okayama Spine Group.
....Name | Company | Catalog Number | Comments |
Adjustable hinged operating carbon table | Mizuho OSI | 6988A-PV-ACP | OSI Axis Jackson table |
CD Horizon Solera Voyager | Medtronic | 6.4317E+11 | Percutaneous pedicle screw system |
Navigated Cobb elevator | Medtronic | NAV2066 | |
Navigated combo tool | Medtronic | NAV2068 | |
Navigated curette | Medtronic | NAV2069 | |
Navigated high speed bur | Medtronic | EM200N | Stelth |
Navigated passive pointer | Medtronic | 960-559 | |
Navigated pedicle probe | Medtronic | 9734680 | |
Navigated shaver | Medtronic | NAV2071 | |
NIM Eclipse system | Medtronic | ECLC | Neuromonitouring |
O-arm | Medtronic | 224ABBZX00042000 | Intraoperative CT |
Radiolucent open spine cramp | Medtronic | 9731780 | |
Self-retaining retractor | Medtronic | 29B2X10008MDT151 | |
Sovereign Spinal System | Medtronic | 6.4317E+11 | OLIF51 cage |
Spine small passive frame | Medtronic | 9730605 | |
Stealth station navigation system Spine 7R | Medtronic | 9733990 | Navigation |
U-NavLock Gray | Medtronic | 9734590 | |
U-NavLock Green | Medtronic | 9734734 | |
U-NavLock Orange | Medtronic | 9734683 | |
U-NavLock Violet | Medtronic | 9734682 |
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