General Session: MIS - Hall F
Presented by: H. Abbasi
H. Abbasi(1), A. Abbasi(2)
(1) Tristate Brain and Spine Institute, Alexandria, MN, United States
(2) University of Chicago, Pritzker School of Medicine, Chicago, IL, United States
Introduction: Minimally Invasive (MI) fusions of the lumbar spine are associated with lower complication rates and improved outcomes relative to their open equivalents, but have not gained widespread acceptance in part because they are technically challenging procedures. Oblique Lateral Lumbar Interbody Fusion (OLLIF) is a new MI fusion of the lumbar spine that is technically straightforward, because it does not require direct visualization. In OLLIF the disk space is approached through Kambin's triangle guided by electrophysiological monitoring and biplanar fluoroscopic imaging. Unlike other MI fusions, OLLIF does not require facetectomy or laminectomy. This is the first comparative study of perioperative and clinical outcomes in patients undergoing OLLIF compared to TLIF.
Methods: This is a retrospective cohort study of 303 OLLIF surgeries on 568 levels with a control group of 54 open TLIFs on 153 levels, all performed by the same surgeon. We compared OLLIF to TLIF on perioperative outcomes and complication rates. For OLLIF patients, we also compared patient reported pain and disability on the oswestry disability index (ODI) pre-op to nine months post-op. Detailed imaging for OLLIF patients was read by two independent radiologists at the one year follow up.
Results: For a single level fusion, OLLIF cuts surgery times and hospital stay in half relative to TLIF (57/135 min, 4.2/2.2 days respectively) and reduces blood loss by almost 90% (355/42ml). Rates of nerve irritation and hardware failure are lower in OLLIF patients compared to TLIF patients. At follow up at least 9 months post-op, OLLIF patients' pain on a 10-point scale was reduced from 8.5±1.2 to 3.9±2.9 (N=213, p< 0.001) and disability on the ODI was reduced from 55%±17% to 36%±21% (N=141, p< 0.001). Interbody Fusion was achieved in 98.4% of OLLIF patients who had imaging done at the 1 year follow up (N=164).
Conclusions: OLLIF is a MI fusion of the lumbar spine that is safe and effective. OLLIF is technically less demanding than comparable procedures resulting in a steep learning curve for the surgeon. OLLIF can be applied from T12-L1 to L5-S1 and can be adapted to correct spinal deformities like scoliosis and for fusions of the thoracic spine. OLLIF warrants further study as it has the potential to improve clinical outcomes relative to the current standard of care.