Surgical indications and application techniques of oblique lateral lumbar interbody fuion for the treatment of lumbar degenerative diseases
10.3760/cma.j.cn121113-20250413-00356
- VernacularTitle:腰椎斜外侧椎体间融合术治疗腰椎退行性疾患的手术适应证和应用技巧
- Author:
Shunwu FAN
1
;
Zhijun HU
1
;
Honghai SONG
1
Author Information
1. 浙江大学医学院附属邵逸夫医院骨科，杭州 310016
- Publication Type:Journal Article
- Keywords:
Lumbar vertebrae;
Spinal fusion;
Intervertebral disc degeneration
- From:
Chinese Journal of Orthopaedics
2025;45(18):1161-1168
- CountryChina
- Language:Chinese
-
Abstract:
Oblique lateral interbody fusion (OLIF) is a minimally invasive fusion technique developed over the past decade. It employs a retroperitoneal approach, accessing the target intervertebral disc through the natural anatomical corridor between the abdominal vascular sheath and the anterior margin of the psoas muscle, thereby avoiding interference with the intraspinal neural structures. Surgical exposure is the cornerstone of the OLIF technique. Imaging and anatomical studies indicate that the natural space between the anterior psoas and the abdominal vessels is relatively narrow, generally smaller than the diameter of OLIF working channel. A direct visualization technique for anterior-inferior psoas exposure by dissecting and retracting the anterior psoas border, can expand this gap by dissecting and retracting the anterior psoas border, making the operation of OLIF techniques in various complex anatomies safer. Currently, OLIF is widely used for various lumbar degenerative diseases, such as discogenic low back pain, lumbar spinal stenosis, lumbar spondylolisthesis, lumbar segmental instability, degenerative lumbar scoliosis, and revision surgery after posterior lumbar surgeries. In the treatment of lumbar spinal stenosis, OLIF achieves indirect decompression of the spinal canal through disc space distraction and stabilization, avoiding intraspinal neural manipulation and related complications. However, it is crucial to select appropriate cases where the disc space has potential for distraction or exhibits intervertebral instability. For degenerative lumbar scoliosis, the corrective principle of OLIF is to restore intervertebral balance and segmental lordosis, thereby reconstructing coronal and sagittal balance of the spine. However, OLIF is not suitable for correcting deformities in patients with rigid posterior lumbar scoliosis or those with type C coronal imbalance. The stand-alone OLIF technique best embodies the minimally invasive concept of OLIF technology, but it has a narrow range of indications and is only applicable to cases where the vertebral endplate strength is sufficiently high (with normal bone mineral density or endplate sclerosis). Supplemental posterior instrumentation is strongly recommended in cases of: reduced bone density (T-score<-1.0), intraoperative endplate injury, multi-level fusion (≥3 segments), isthmic spondylolisthesis, grade II degenerative spondylolisthesis or higher, dynamic instability confirmed by dynamic X-ray films, adjacent segment disease distal to prior fused segments, intraoperative trial implant loosening. There are various options for internal fixation in the OLIF technique; however, bilateral posterior pedicle screw fixation remains the current gold standard for rigid fixation. For some cases with normal bone mineral density and sufficient support strength of the cage, lateral fixation can be used instead of posterior internal fixation to prevent cage displacement. As a novel minimally invasive lumbar fusion technique, OLIF requires ongoing refinement of clinical experience. Through multi-center and large-scale case studies, the standardization and homogenization of its application should be explored.
