Oblique Lumbar Interbody Fusion at L5-S1 Segment Through an Approach Between the Psoas Muscle and the Great Vessels

Summary

The protocol presents an OLIF L5-S1 technique that offers a more feasible approach for lumbosacral fusion sharing a common surgical plane with OLIF L2-5. This facilitates reproducible multi-level interbody fusions extending from L2 to S1 through a retroperitoneal oblique corridor between the Psoas muscle and the great vessels.

Abstract

Over the years, the oblique lateral interbody fusion (OLIF) technique has gained significant recognition for treating various spinal conditions in lumbar segments L2-L5. However, the adoption of OLIF for the L5-S1 segment has not been widely embraced by the spinal surgery community, given that significant concerns remain regarding the applicability of OLIF for lumbosacral fusion. In this study, a cohort of 20 patients underwent interbody fusion at the L5-S1 level using the OLIF technique through a single retroperitoneal oblique approach positioned between the Psoas muscle and the great vessels. The procedure involved discectomy and endplate preparation accomplished through a surgical window created on the anterolateral side of the L5-S1 disc. For secure interbody fusion cage placement, a supplementary cage insertion approach was employed. All patients were followed up for a minimum of 12 months. The mean preoperative visual analog scale (VAS) score for lower back pain was 6.3 ± 1.5 and experienced a significant reduction to 1.2 ± 0.8 at 12 months. The VAS score for lower limb pain significantly decreased from 5.6 ± 1.4 preoperatively to 0.8 ± 0.3 at 12 months after the surgery. Furthermore, the preoperative Oswestry disability index (ODI) improved from 82.4% ± 16.2% to 8.1% ± 2.0% at 12 months. Radiographic evaluations after surgery confirmed improved lumbosacral junction reconstruction for all patients. At the final follow-up, successful bony fusion was observed in all cases. Based on these findings, the OLIF technique for L5-S1 fusion represents an attainable approach for lumbosacral reconstruction. The procedure's success hinges on a comprehensive preoperative plan and precise intraoperative techniques.

Introduction

Lumbar interbody fusion represents the mainstay of treatment for many lumbar disorders. The most commonly performed techniques are posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF). The advent of minimally invasive spine surgery has given rise to the lateral lumbar interbody fusion (LLIF) approach, a minimally invasive transpsoas approach to the lumbar spine. This approach, also known as the minimally invasive lateral transpsoas approach, offers advantages, including reduced blood loss, shorter operative times, decreased hospital stays, and diminished postoperative pain. Despite its merits, LLIF is associated with a risk of inj....

Protocol

This study was carried out in accordance with the clinical ethics committee guidelines of the First Affiliated Hospital of Zhejiang University. Written informed consent was obtained from all participating patients. The OLIF L5-S1 technique is indicated for patients with various spinal pathologies of L5-S1 involving degenerative disc disease, lumbar spondylosis, low-grade spondylolisthesis, and scoliosis. Patients with a history of trauma, neoplasia, or infection were excluded.

1. Patient.......

Discussion

An increasing body of evidence from recently published studies suggests that OLIF therapy brings technical advantages and favorable outcomes for lumbar degenerative diseases, especially in the L2-5 segments^2,5,6,7. While recognizing these benefits, efforts have been made to extend the use of OLIF to the lumbosacral junction. However, the technical strategy for performing OLIF at L5-S1 remains s.......

Materials

Name	Company	Catalog Number	Comments
Fluoroscopy System	Allengers
Handheld retractor	gSource	gS 36.9362
Kirschner wire	Sklar surgical instruments	SKU 40-1535
OLIF cages	Medtronic Sofamor Danek, Memphis, Tennessee, USA
Pedicle screws	Beijing Fule Technology Development Co. , Ltd China
Tonsil sponge	teleflex	MC-008133
Vascular clamp