Berry CA. Nuances of oblique lumbar interbody fusion at L5-S1: Three case reports. World J Orthop 2021; 12(6): 445-455 [PMID: 34189082 DOI: 10.5312/wjo.v12.i6.445]
Corresponding Author of This Article
Chirag A Berry, MD, Assistant Professor, Department of Orthopaedics, Cincinnati VA Medical Center, 3200 Vine Street, Cincinnati, OH 45220, United States. berrycg@ucmail.uc.edu
Research Domain of This Article
Orthopedics
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Jun 18, 2021; 12(6): 445-455 Published online Jun 18, 2021. doi: 10.5312/wjo.v12.i6.445
Nuances of oblique lumbar interbody fusion at L5-S1: Three case reports
Chirag A Berry
Chirag A Berry, Department of Orthopaedics, Cincinnati VA Medical Center, Cincinnati, OH 45220, United States
Author contributions: Berry CA contributed to all aspects of this manuscript, namely, conception, design, data collection and interpretation, literature review, primary surgeon of all patients, drafting, revisions, and final approval.
Informed consent statement: Informed written consent was obtained from each patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The author declares that they have no conflict of interest.
CARE Checklist (2016) statement: The author has read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chirag A Berry, MD, Assistant Professor, Department of Orthopaedics, Cincinnati VA Medical Center, 3200 Vine Street, Cincinnati, OH 45220, United States. berrycg@ucmail.uc.edu
Received: February 15, 2021 Peer-review started: February 15, 2021 First decision: May 3, 2021 Revised: May 4, 2021 Accepted: May 27, 2021 Article in press: May 27, 2021 Published online: June 18, 2021 Processing time: 116 Days and 6.3 Hours
Abstract
BACKGROUND
Oblique lumbar interbody fusion is a mini-open retroperitoneal approach that uses a wide corridor between the left psoas muscle and the aorta above L5. This approach avoids the limitations of lateral lumbar interbody fusion, is considered less invasive than anterior lumbar interbody fusion, and is similarly effective for indirect decompression and improving lordosis while maintaining a low complication profile. Including L5-S1, when required, adds to these advantages, as this allows single-position surgery. However, variations in vascular anatomy can affect the ease of access to the L5-S1 disc. The nuances of three different oblique anterolateral techniques to access L5-S1 for interbody fusion, namely, left-sided intra-bifurcation, left-sided pre-psoas, and right-sided pre-psoas approaches, are illustrated using three representative case studies.
CASE SUMMARY
Cases of three patients who underwent multilevel oblique lumbar interbody fusion including L5-S1, using one of the three different techniques, are described. All patients presented with symptomatic degenerative lumbar pathology and failed conservative management prior to surgery. The anatomical considerations that affected the decisions to utilize each approach are discussed. The pros and cons of each approach are also discussed. A parasagittal facet line objectively assesses the relationship between the left common iliac vein and the L5-S1 disc and assists in choosing the approach to L5-S1.
CONCLUSION
Oblique retroperitoneal access to L5-S1 in the lateral decubitus position is possible through three different approaches. The choice of approach to L5-S1 may be individualized based on a patient’s vascular anatomy using preoperative imaging. While most surgeons will rely on their experience and comfort level in choosing the approach, this article elucidates the nuances of each technique.
Core Tip: Oblique lumbar interbody fusion (OLIF) provides safe retroperitoneal access to nearly all lumbar levels, including L5-S1, thus, allowing single-position surgery. L5-S1 OLIF access may be attempted through three alternative approaches — left intra-bifurcation, left pre-psoas and right pre-psoas approaches — the choice of which can be customized according to the patient’s vascular anatomy.
