Author(s): Di Benedetto M.G.; Deeherendra S.; Clark S.; Teli M.
Source: European Spine Journal; 2017; vol. 26 (no. 2)
Publication Date: 2017
Publication Type(s): Conference Abstract
Available at European Spine Journal – from SpringerLink – Medicine
Abstract:Background: Lumbar interbody fusion has been accepted as an effective procedure in the management of spinal conditions such as degenerative disease, spondylolisthesis, disc herniation and deformities. Over the past decade the trend in lumbar spinal fusion surgery has progressively evolved and recently minimally invasive lateral/ anterolateral retroperitoneal approach for anterior lumbar interbody fusion have gained popularity providing another corridor to access the lumbar spine with several advantages over conventional open anterior and posterior/transforaminal lumbar interbody fusion. Purpose: This study investigated advantages, pitfalls and complications of minimally invasive approach for anterior lumbar interbody fusion by using a lateral/anterolateral retroperitoneal approaches including OLIF and XILIF/DLIF Methods: A comprehensive review of available literature has been performed. The keywords “XLIF”, “extreme lateral approach lumbar spine”, “lateral approach lumbar interbody fusion”, “OLIF”, “oblique lumbar interbody fusion” were used to search for relevant articles. The literature were analyzed for radiographic and clinical outcomes (neurological outcomes, fusion rate, misalignment restoration and rate of adverse events). Results: OLIF and XILIF/DLIF are relatively new minimally invasive techniques that allow to access the intervertebral space from a unilateral approach anterior to or through the psoas muscle. These procedures minimize vascular and visceral injury related with anterior approach and completely preserve the posterior musculature. Successful fusion rate, significant pain scores improvement, good sagittal and coronal deformity correction have been reported. Operative time and blood loss are decreased with an early patient mobilization and reduced length of stay in hospital. XILIF/DLIF approach offer an easy access to lumbar multiple levels except for L5-S1 due to obstruction by the iliac crest at that level. The transpsoas retroperitoneal corridor is used to access the disc space with potential risks of lumbar plexus. The majority of the studies report a transient postoperative anterior thigh symptoms including pain, numbness and paresthesias as a result of lumbar plexus injury or indirect compessive neuropathy. The OLIF technique is suitable for levels L1-S1 and preserves psoas muscles as the approach is anterior to it. However, potential risks with OLIF surgery are vascular and indirect lumbar plexus injury. Conclusion: Based on the existing literature, lateral approaches to anterior lumbar spine including OLIF and XILIF/DLIF are promising and feasible minimally invasive surgical method for treatment of a range of spinal degenerative disorders requiring lumbar spine fusion. However, further clinical studies and long term outcomes are needed to assess the reliability of this technique, in addition further data and biomechanical studies are required to establish their effectiveness of restoring the sagittal misalignment. (Figure presented).