General Session: Innovative Technologies II - Hall F

Presented by: R. Hynes

Author(s):

R. Hynes(1), Y. Rivera-Colon(2), M. Oh(3), D. Datta(4), A. Yu(3), J. Cannas(5), D. Prestamburgo(6), S. D'Houtard(7), K. Woods(8)

(1) Florida Institute of Technology, Biomedical Engineering, Melbourne, FL, United States
(2) Puerto Rico Spine Center, Santurce, Puerto Rico
(3) Allegheny Health Network, Pittsburgh, PA, United States
(4) The B.A.C.K Center, Melbourne, FL, United States
(5) CUF Descobertas, Lisbon, Portugal
(6) Azienda Ospedaliera - Ospedale Civile di Legnano, Legano, Italy
(7) Clinique Du Mail, La Rochelle, France
(8) Kettering Medical Center, Kettering, OH, United States

Abstract

Purpose: To demonstrate the safety of the OLIF including the L5-S1 level in the early postoperative period.

Methods: Multicenter prospective data. This is a multi-center study including eight centers performing the OLIF approach for primarily degenerative disorders of the lumbar spine. Patients agreed to data collection and IRB approvals were obtained. Patient reported outcomes (PRO), surgical information and complications were obtained for review.

Summary of Findings: Of 153 subjects enrolled in this study, 42 underwent a multi-level OLIF procedure including L5-S1. The subject sample included, 27 males and 15 females, the mean age was 63.9 years. There were seven single stage cases and 35 two-stage cases. There was an average of three levels per cases. Overall mean EBL per case was 163.9cc., operative time per case was 185.6 minutes, mean hospital stay was 5.5 days There were nine stand-alone constructs vs. 33 OLIF and posterior instrumentation cases. Neuromonitoring was utilized in 34 cases. Prior to discharge, there was one paresthesia and 5 weaknesses reported in 4 subjects, at 6 weeks, one of these events had resolved. There were no reports of vascular injuries, retrograde ejaculation, or ventral hernia in these 42 subjects. ODI (p=0.03) and both back (p< 0.001) and leg (p< 0.03) VAS pain had statistically significant improvements from baseline at 3 months postoperatively. The EQ5D demonstrated a non-significant improvement (p = 0.11). Conclusions and

Discussion: OLIF including the L5S1 level is a safe procedure and approach to the lumbar spine. OLIF for the L2L5 levels (O25) using the corridor anterior to the psoas, facilitates lateral interbody fixation with minimal to no risk to femoral and obturator nerve while obviating the postoperative muscle pain that occurs with complimentary transpsoas procedures. OLIF for the L5S1 level (O51), is as safe and less invasive than the supine L5S1 ALIF approach and eliminates the requirement to flip the patient in these cases that require Lumbar fusion at L45 and L5S1. This is extremely beneficial considering that 60% of the lumbar lordosis is based in these two specific levels and the concomitant high incidence of discopathology which includes L4-S1. Although not statistically significant, injury to the Superior Hypogastric Plexus (SHP), the cause of retrograde ejaculation, was not found. There is the possibility if not the probability that by lessening the traction, displacement and retraction blade forces on the retroperitoneum during O51 compared the ALIF, that the SHP is at less risk a crush injury, vascular supply injury and traction injury. Incidence of ileus was low due to more minimally invasive retroperitoneal exposure compared to ALIF. Significant improvement noted in the Patient Reported Outcomes is expected considering OLIF mitigates psoas injury and major nerve injury by using the corridor anterior to the psoas for the approach. This as well as no major vessel mobilization nor ligation of the iliolumbar vein in O51 compared to ALIF results in at least equivalent safety profile for the inclusion of the L5S1 disk level, not previously possible with other lateral approaches to the lumbar spine.