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Oblique lateral interbody fusion at L5-S1: feasibility, surgical approach window, incision line, and influencing factors

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Abstract

Purpose

The primary aim of this study was to describe the feasibility, surgical approach window (SAW), and incision line (IL) for oblique lateral interbody fusion at L5-S1 (OLIF51) using computed tomography (CT). A secondary aim was to identify associations among approach characteristics and demographic and anthropometric factors.

Methods

We performed a radiographic study of 50 male and 50 female subjects who received abdominal CT imaging. SAW was measured as the distance from the midline to the medial border of the iliac vessel. IL was measured at the skin surface corresponding to the distance between the center of the disc space and SAW lateral margin. OLIF51 feasibility was defined as the existence of at least a 1-cm SAW without retraction of soft tissues.

Results

For the left side, the OLIF51 SAW and IL were 12.1 ± 4.6 and 175.1 ± 55.3 mm. For the right side, these measures were 10.0 ± 4.3 and 185.0 ± 52.5 mm. Correlations of r = 0.648 (p < 0.001) and r = 0.656 (p < 0.001) were observed between weight and IL on the left and right sides, respectively. OLIF51 was not feasible 23% of the time.

Conclusion

To our knowledge, this is the largest CT study to determine the feasibility of performing an OLIF51. Without the use of retraction, OLIF51 is not feasible 23% of the time. Left-sided OLIF51 allows for a larger surgical approach window and smaller incision compared to the right side. Larger incisions are required for adequate surgical exposure in patients with higher weight.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Loma Linda University Health, Loma Linda, CA, USA

    Rusheel Nayak & Olumide Danisa

  2. School of Medicine, Loma Linda University, Loma Linda, CA, USA

    Jacob Razzouk & Gideon Harianja

  3. Twin Cities Spine Center, Minneapolis, MN, USA

    Omar Ramos

  4. University of California Riverside, Riverside, CA, USA

    Shaurya Mehta

  5. Department of Radiology, Loma Linda University Health, Loma Linda, CA, USA

    Nathaniel Wycliffe

  6. Division of Orthopaedic Surgery, Jerry L. Pettis VA Medical Center, 25805 Barton Road A106, Loma Linda, CA, 92354, USA

    Wayne Cheng

Authors
  1. Rusheel Nayak
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  2. Jacob Razzouk
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  3. Omar Ramos
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  4. Shaurya Mehta
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  5. Gideon Harianja
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  6. Nathaniel Wycliffe
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  7. Olumide Danisa
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  8. Wayne Cheng
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Corresponding author

Correspondence to Wayne Cheng.

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Conflict of interest

The authors did not receive support from any organization for the submitted work. Dr. Cheng reports nonfinancial support from K2m during the conduct of the study; he also reports personal fees from Depuy (A Johnson & Johnson Company) and Alphatec Spine, and grants from Medtronic, K2M, Biomet, Ortho Fix, and NuVasive outside the submitted work. Dr. Danisa reports grants and personal fees from Globus Medical, grants from NuVasive, Medtronic, and Musculoskeletal Transplant Foundation outside the submitted work; he is affiliated with The Spine Journal, AAOS Medical Education Committee, and NASS Resident/Fellowship Committee.

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Nayak, R., Razzouk, J., Ramos, O. et al. Oblique lateral interbody fusion at L5-S1: feasibility, surgical approach window, incision line, and influencing factors. Eur Spine J (2024). https://doi.org/10.1007/s00586-023-08017-4

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