RADIOGRAPHIC ASSESSMENT OF INDIRECT DECOMPRESSION OF SPINAL CANAL WITH OLIF

SEAN KEEM, MD, MBASPINE SURGEONSEATTLE, WASHINGTON

E-poster #49

OLIF (OBLIQUE LATERAL INTERBODY FUSION)

▪ An MIS procedure where decompression of spinal canal and reduction of spinal deformity is achieved with ligamentotaxis and facet distraction through ante-psoas approach

▪ Similar to any direct LLIF (Lateral Lumbar Inberbody Fusion) in intervertebral correctional properties

▪ Large bone-implant contact surface creates stable environment to facilitate fusion →rare non-union

▪ Implant placement on ring apophysis → Less subsidence of graft, better deformity correction with fewer fused segments

▪ Stand-alone fusion makes extension to adjacent segment easy without having to revise previous instrumentation

TLIF LLIF/ OLIFPLIF

Grant et al., Spine 2001;26(8):889-8

BETTER LIGAMENTOUS TAXIS WITH OLIF IN CANAL DECOMPRESSION/DEFORMITY CORRECTION

▪Access over lower part of iliac crest

▪ Flexing at the pelvis is not required for L4-5 access

▪ Lumbar plexus is not in tension as the result

▪Decompression in front of lumbar plexus vs. in the middle of lumbar

plexus as with Direct LLIFs

▪ Neurological injury rare▪ Hip flexion, knee extension and ADF weakness rare

▪ Can be aggressive with large implant to achieve True Ligamentotaxis:

10 mm height implant usage is routine. Often 12 mm. 14 mm not uncommon.

▪ Transitional anatomy is not contraindicated

CASE 1

Scoliosis/stenosis

66 yo F sculptor

Chronic back pain

Neurogenic claudication

Scoliosis 42˚

Sharp rotational deformity

IBD

Osteoporosis

T9-S1(2) fusion recommended

by 5 other spine surgeons

OLIF L2-5 + DLIFL1-2 + PPSF

Surgical time 4 hrs

EBL 50 ml

3-day hospital stay

Doing well at 1 year PO

L1-2 L2-3 L3-4 L4-5

Post op canal decompression with OLIF

Pre op

CASE 2

• Grade 2-3 Isthmic

spondylolisthesis/stenosis

• 74 yo F

• Chronic progressively worsening back

pain all her life. “Cannot do anything

w/o hurting”

• Walks < 1 block (100m)

• CAD (CABG x4), PVD, smoker!

OLIF L3-S1+ PPSF L3-S1

Surgical time 3.5 hours

EBL < 30 ml

Discharged on POD 3

Doing well: walks 3 miles/day

L3-4 L4-5 L5-S1

Post op canal decompression with OLIF

Pre op

CASE 3

• Stenosis/lateral listehsis

• 72 yo M lumberjack

• Debilitating back and leg pain, and

worsening leg weakness for several

years

• Laminectomy 6 yrs ago

• 7 LESI following surgery

• Walks <100 m

• IDDM

OLIF L2-S1 + DLIF T12-L2 + PPSF T12-S1

• Surgical time 4.5 hours. EBL<30 ml.

Discharged POD 3

• Doing well at 9 months post op. Leg pain,

weakness, numbness and pain resolved.

L1-2 L2-3 L3-4 L4-5

Post op canal decompression with OLIF

Pre op