Transfacet Oblique Lateral Lumbar Interbody Fusion: Technical Description and Early Results

. 2022 Jul 3;14(7):e26533.


doi: 10.7759/cureus.26533.


eCollection 2022 Jul.

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Hamid Abbasi et al.


Cureus.


.

Abstract

Introduction The oblique lateral lumbar interbody fusion (OLLIF) is a relatively new method of lumbar interbody fusion (LIF) that utilizes a trans-Kambin approach to the disc space. The OLLIF can be performed from T12-S1 in the majority of cases but is occasionally obstructed at the L5-S1 level by osteophytes, an overgrown facet joint and/or prominent sacral ala. Transfacet OLLIF (TF-OLLIF) is a novel method for LIF in which the disc space is accessed by drilling through hypertrophic facets with an OLLIF approach. We provide a proof-of-concept report on the TF-OLLIF surgical technique and report the clinical and perioperative outcomes for the first 29 patients who underwent this procedure. Methods This is a retrospective single surgeon cohort study of 29 patients with lumbar spinal stenosis (LSS) who underwent TF-OLLIF procedures between 8/2018 and 1/2021. The primary outcome was a change in the Oswestry Disability Index (ODI) one year after surgery. Secondary outcomes were surgery time, blood loss, hospital stay, and complications. The TF-OLLIF was performed using the approach and instrumentation of OLLIF. When osseous hypertrophy is reached during the approach, an 8 mm drill is used to drill through the obstructing bone with continuous neuromonitoring. Discectomy and interbody placement are performed with subsequent posterior pedicle screw fixation. Results ODI improved from 49% pre-op to 31% at one-year follow-up. Estimated blood loss ranged from 97.6±93.3 ml for one level TF-OLLIF to 146.2±60.3 ml for a 3+ level TF-OLLIF. Operative time ranged from 57.4±19.5 minutes for a one-level TF-OLLIF to 102.9±27.8 minutes for a 3+ level TF-OLLIF. The average length of hospital stay (LOS) was 0.4±0.8 days for one-level TF-OLLIF and 1.6±1.9 days for 3+ level TF-OLLIF. Complications included five cases of nerve root irritation immediately postoperatively, with three of these patients still reporting mild L5 distribution numbness at the last follow-up, which was not clinically limiting. Conclusion The first 29 cases of TF-OLLIF demonstrated that it is a safe method of interbody fusion that yields good clinical results. This is an important development for practitioners of OLLIF as it enables interbody placement with OLLIF instruments and approach even for challenging L5-S1 levels without compromising surgical outcomes.


Keywords:

l5-s1 level; lumbar interbody fusion; minimally invasive surgery; oblique lateral lumbar interbody fusion; ollif; spinal fusion; spine.

Conflict of interest statement

Hamid Abbasi owns multiple patents related to minimally invasive spinal surgery.

Figures


Figure 1



Figure 1. Depiction of Kambin’s triangle


Figure 2



Figure 2. K-wire placement on the hypertrophied facet

Lateral (left) and anterior/posterior (AP, right) of K-wire placement following the docking of the blunt probe on the hypertrophied facet.


Figure 3



Figure 3. Approach through the hypertrophied facet is drilled through the access portal

Lateral (left) and anterior/posterior (AP, right) fluoroscopy of the drill being used.


Figure 4



Figure 4. The dilator is entered into the disc space

Lateral (left) and anterior/posterior (AP, right) fluoroscopy of the access portal being entered into the disc space, expanding the disc space and allowing the entrance of the access portal.


Figure 5



Figure 5. The cage is placed after discectomy and placement of the K-wire

The top left and top right images are lateral and anterior/posterior (AP) fluoroscopy, respectively, of the interbody as it reaches the disc space. The bottom left and right images are lateral and AP fluoroscopy of the final interbody placement.


Figure 6



Figure 6. Instruments and implants used for interbody placement in transfacet OLLIF

Instruments from left to right: neuromonitoring probe, K-wire, dilator, access portal, impactor, mallet, 8mm drill, paddle shaper and blade, pituitary rongeur, flexible curette, articulating rake, graft delivery tube and graft tamp,  inserter set (separated and assembled), and wrench. Interbodies are seen on the bottom right. OLLIF – oblique lateral lumbar interbody fusion

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References

    1. Low back pain, a comprehensive review: pathophysiology, diagnosis, and treatment. Urits I, Burshtein A, Sharma M, et al. Curr Pain Headache Rep. 2019;23:23.



      PubMed

    1. Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial. Weinstein JN, Tosteson TD, Lurie JD, et al. Spine. 2010;35:1329–1338.



      PMC



      PubMed

    1. Management of lumbar spinal stenosis. Lurie J, Tomkins-Lane C. BMJ. 2016;352:0.



      PMC



      PubMed

    1. Lumbar spinal stenosis. Genevay S, Atlas SJ. Best Pract Res Clin Rheumatol. 2010;24:253–265.



      PMC



      PubMed

    1. Postoperative instability after decompression for lumbar spinal stenosis. Johnsson KE, Willner S, Johnsson K. Spine. 1986;11:107–110.



      PubMed

Grant support

This work was funded by MIS Technologies, LLC

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