Anterior to Psoas/Oblique Lumbar Interbody Fusion for the Treatment of Degenerative Disease of the Lumbar Spine

https://doi.org/10.59156/revista.v37i03.489

Abstract

Background:  oblique lumbar interbody fusion (OLIF) is a minimally invasive alternative to traditional open interbody fusion. It allows the surgeon to access the disc space via a retroperitoneal approach anterior to the psoas muscle. It has the theoretical advantage of preservation of the longitudinal ligaments, augmentation of the disc height with indirect decompression of neural elements and insertion of large footprint cages.

Objective: the purpose of this study was to asses the clinical outcomes of a consecutive series of 32 patients who underwent oblique lumbar interbody fusion for degenerative lumbar spine disease.

Material and Methods: Thirty-two patients with radiological findings of degenerative lumbar spine disease had undergone OLIF between January 2017 and June 2019. Clinical outcomes were assessed by means of Oswestry Disability Index (ODI), Visual Analog Scale (VAS) for back pain and VAS for leg pain, before surgery and at first year follow-up. Furthermore, the following parameters were retrospectively reviewed: age, gender, type of degenerative disease, number of levels of fusion, operative time, length of hospital stay and surgical complications

Results: 42 interbody cages were implanted in 32 patients. 56,25% of the patients were female, with a mean age of 56 years.  The number of fused levels was 1 in 21 patients (65,6%), 2 in 7 patients (21,9%) and 3 in 4 patients (12,5%). The fused level was L1-L2 in 2 patients (4,76%%), L2-L3 in 7 patients (16,67%%), L3-L4 in 12 patients (28,57%) and L4-L5 in 21 patients (50%).  The mean operative time was 153,13 (88-210) minutes and the mean length of hospital stay was 2,53 days (1-5). Statistical analysis showed significance for the results in ODI, VAS for back pain and VAS for leg pain. 4 patients presented transient psoas paresis from traction of the muscle. Transient groin and thigh numbness was present on three patients and one patient had a sympathetic plexus injury.

Conclusion: OLIF offers patients a safe and effective surgical treatment option to treat degenerative lumbar spine disease.