Minimally Invasive Multilevel Oblique Lumbar Interbody Fusion (OLIF): An Anatomical Single Position Approach for CMIS Correction of Adult Spinal Deformity (ASD)

Presented at SMISS Annual Forum 2018
By Neel Anand MD
With Edward Nomoto MD, Christopher Kong MD, Babak Khandehroo MD, Sheila Kahwaty PA-C,

Disclosures: Neel Anand MD None Edward Nomoto MD None, Christopher Kong MD None, Babak Khandehroo MD None, Sheila Kahwaty PA-C None,

Introduction:

Lateral Transpsoas Interbody fusion surgery has been an effective adjunct to Circumferential MIS treatment of ASD. Recently an oblique lateral approach allows retroperitoneal access to the lumbar spine, anterior to the psoas preserving the psoas muscle and lumbar plexus. Additionally, the approach allows for access to all the lumbar levels including L5-S1 with single lateral positioning.

Aims/Objectives:

This study was conducted to review the safety and feasibility of multilevel OLIF for MIS treatment of ASD.

Methods:

We reviewed our prospectively collected data registry of 158 consecutive ASD (Cobb angle>20 or SVA>50mm or PI/LL mismatch>10) patients who underwent CMIS correction from May 2011 to Jun. 2017. Considering 4+ levels fused, 1-year follow-up and having Multilevel lumbar OLIF included 93 pts for this study. In all patients, multilevel oblique LLIF±L5-S1 OLIF/ALIF were done in the first stage. The patients were ambulated after a standing radiograph obtained 2 days later and further correction of alignment was planned for the second stage accordingly. 3 days later MIS pedicle screws with aggressive rod contouring and derotation/translation was done.

Results:

Mean age was 66.6 yrs (45-85) with mean follow-up of 46.5 months (12-84). Total of 447 lumbar interbody fusions levels (L1-S1) were done by lateral oblique approach. The mean pre-op Cobb angle of 31.5 (10-69.9) was corrected to 12.8 (0-40.7) (p<.05) post-op. The mean pre-op Lumbar lordosis of 39.7 (8.3-78.2) was corrected to 49.2 (23-88.2) post-op. The mean pre-op PI/LL mismatch of 15.7 (0.5-60.4) corrected to 9 (0.2-28.9) (p<.05) post-op. The mean pre-op SVA of 59.9mm (9.6-201.8) was corrected to 32.5mm (0-98) (p<.05) post-operatively. 2 intra-op complications occurred: one patient had an avulsed segmental artery which was controlled successfully, one patient had ureteral injury and underwent nephrostomy with delayed repair. There was no sympathetic chain injury, transient/permanent postoperative lumbar plexopathy, bowel injury, renal injury nor prolonged postoperative ileus. 7 patients had post-op complications: 3 hardware failure, 1 foraminal stenosis and 3 with PJK: 2 of them underwent revision surgery and extended posterior instrumentation and 1 remained asymptomatic and declined any revision. No postoperative pseudoarthrosis has occurred.

Conclusions:

Mid to long term results suggest that multilevel OLIF for interbody fusion in staged CMIS correction of ASD is a safe and effective technique in improving sagittal and coronal alignment with low risk of perioperative and postoperative complications.