General Session: Endoscopic Surgery
Presented by: H. Abbasi - View Audio/Video Presentation (Members Only)
H. Abbasi(1), A. Abbasi(2)
(1) Tristate Brain and Spine Institute, Alexandria, MN, United States
(2) Trinity College, University of Cambridge, Edina, MN, United States
Background: Lower back pain is one of the most prevalent and expensive health conditions in the Western world. The standard treatment, interbody fusion, is an invasive procedure that requires the stripping of muscles and soft tissue, leading to surgical morbidity. Current minimally invasive (MI) spinal fusions are technically demanding and suffer from technical limitations.
Purpose: Oblique lumbar lateral interbody fusion (OLLIF) is a new technique for fusion of the lumbar spine that overcomes these complications. Outcome measures include patient demographics, reported outcomes, and surgical outcomes.
Study Design/Setting: Kambin´s Triangle can easily be located as a silent window with an electrophysiological probe. Discectomy is performed through a single access portal with a 10 mm diameter. After a discectomy, the disc space is packed with beta-tricalcium phosphate soaked in autologous bone marrow, aspirated, and the cage is inserted. Finally, a minimally invasive posterior fixation is performed.
Methods: OLLIF's major innovation is to approach the disc through Kambin's Triangle, aided by bilateral fluoroscopy.
Results: We present data from 69 consecutive OLLIF surgeries on 128 levels with a control group of 55 consecutive open transformational lumbar interbody fusions (TLIFs) on 125 levels. For a single level OLLIF, the mean surgery time is 69 minutes (min) and blood loss is 29 ml. Surgery time was approximately twice as fast as open TLIF (mean: 135 min) and blood loss is reduced by over 80% compared to TLIF (mean: 355 ml).
Conclusions: OLLIF is a minimally invasive fusion that significantly reduces surgery times compared to open surgery. OLLIF overcomes the difficulties of traditional open fusions, making it a safe and technically less demanding surgery than open or minimally invasive TLIF.
Introduction: As a treatment for disc disorders, TLIF has been shown to cause less surgical morbidity and, thus, a quicker recovery than PLIF. However, during the approach for TLIF, muscles are still detached and denervated, which may cause significant morbidity. MI TLIF decreases blood loss and complication rates relative to open TLIF, but surgery times are similar or even longer than open TLIF. Postoperative recovery is also reduced in MI TLIF and long-term outcomes are generally as good, but not better than for open TLIF. MI TLIF still requires a fairly generous laminectomy and facetectomy, so it is essentially a traditional open TLIF in which the spine is accessed and directly visualized through a smaller surgical corridor. This makes MI TLIF a technically challenging procedure that has not replaced open TLIF, even though it was developed almost a decade ago. Oblique lateral lumbar interbody fusion (OLLIF) is a new technique that allows for the fusion of the lumbar spine through a single 10-15 mm incision, with faster surgery times and an easier approach than any previous technique. OLLIF eliminates the need for direct visual reference during surgery with the help of electrophysiological monitoring. OLLIF's major innovation is to perform spinal fusion via Kambin's Triangle which is an electrophysiologically silent window, OLLIF requires no direct visualization. We present perioperative outcome data from 69 OLLIF procedures and compare them to 55 open TLIFs done by the same surgeon.