Endo-OLIF is a combined minimally invasive spinal approach which takes full advantages endoscopic spine surgery, O-arm navigation, and minimally invasive technique for anterior spinal fusion. The OLIF procedure is an oblique approach intermediary between an anterior lumbar interbody fusion (ALIF) and a direct lateral lumbar interbody fusion (DLIF). Unlike the ALIF procedure, all major blood vessels are avoided in this approach, and unlike the DLIF procedure, psoas muscles and lumbar plexuses are left undisturbed thereby reducing the risk of postoperative pain and neurological/plexus injury. Occasionally, low-lying rib cage or high iliac crest position is found in some people making it impossible with the direct lateral approach (DLIF) to gain access to high lumbar disc spaces (L1/2 and L2/3) or lower lumbar spaces (L4/5 and L5/S1). By contrast, the oblique approach can access most lumbar disc spaces from L1/2 to L4/5 without difficulties, as it is not hindered by the rib cage or the iliac crest. The Endo-OLIF offers many advantages over traditional lumbar fusion surgery. In older patients, the benefits become much more obvious with less wound pain, less blood loss, and shorter hospital stay. The OLIF implant/cage is wider providing more stability and better support for the anterior spinal column (advantageous in osteoporotic bone). In addition, better correction of lumbar scoliosis and lordosis can be achieved by using larger OLIF implants and by inserting the implant from an oblique/lateral direction (the same direction plane as the scoliotic deformity). The Endo-OLIF procedure is often used in combination with other minimally invasive posterior procedures, such as endoscopic lumbar decompression and/or percutaneous pedicular screw placement. By combining O-arm navigation and spinal endoscopy with the OLIF procedure, surgical precision and better visualization of important anatomical structures can be achieved, thus increasing overall safety and providing better clinical outcome for patients.
Spinal disc degeneration and micro-instability of the lumbar spine can cause mechanical back pain, buttock, groin and hip pain, and nerve root irritations resulting in leg pain. This procedure is designed to stabilize the spine by achieving higher fusion rates to relieve back pain and their associated symptoms, without interfering with nervous tissues thereby avoiding scar formation around nerve roots.
-This procedure offers a definitive problem to help correct damaged intervertebral discs and bone long with the fusion of the 2 adjacent spinal vertebrae
-OLIF may be associated with certain complications, which include bleeding, infection, nerve damage, failure of bone fusion, bowel and bladder difficulties.
Under general anaesthesia with the patient lying usually on his/her right side, the surgeon makes a small incision on left flank to expose the front part of the spine by going around the back of the abdominal cavity along the back wall without having to go through the abdominal cavity or cut through any of the back muscles. After disc material is endoscopically removed from the front of the spine, a synthetic cage with bone substitute is inserted under O-arm navigation into the empty disc space to support and create lumbar fusion, and at the same time restoring disc height and spinal alignment into its natural lumbar curvature. Surgery usually takes about 1 to 2 hours to perform for a one or two-level procedure.
You may have to stay in the hospital for 1 to 2 days or longer depending on your condition. Your doctor will prescribe pain medication and a brace to support your back. Physical therapy is recommended to improve strength and movement after surgery. It may take 3 to 6 weeks for the bones to properly fuse and for you to return to work.
As with any spinal surgery, the risks include: Bleeding from blood vessels Nerve injury with progression of neurological deficit such as leg pain, weakness and numbness, and urinary and defaecation problems Wound Infection Complication related to instruments, e.g. malpositioning and subsidence bone grafts and artificial cages Blood clot in the legs (deep vein thrombosis), which can dislodge and move to the lungs (pulmonary embolism) Anaesthetic complications
What are the indications for the procedure?
The Endo-OLIF surgery is the procedure of choice for treatment and correction of degenerative lumbar scoliosis. Discogenic back pain (single or multiple level) Low grade lumbar spondylolisthesis- bone slip Spinal instability Lumbar spondylosis Degenerative disc disease Failure of previous posterior lumbar fusion surgery with pseudoarthrosis Combined with posterior procedure to enhance bone fusion
What are other types of Lumbar fusion?
PLIF The Posterior Lumbar Interbody Fusion (PLIF) technique was developed in the 1950s and became the “Golden Standard” to treat disc problems. In the procedure, the spine is approached from a 3-6 inch long incision in the middle of the back, and the lower back muscles are stripped off the lamina on both sides. The lamina bone is then removed (laminectomy) to allow the surgeon to see the nerve roots. The facet joints may then be trimmed back to give the nerves more room, before the nerve roots are moved aside and disc space is cleared out of disc material. A fusion cage containing bone graft material is then inserted into the disc space, allowing bone to grow and connect both vertebrae, completing the fusion. This is a more traditional spine fusion and may be required in some cases, however never techniques are available. TLIF The Transforaminal Lumbar Interbody Fusion (TLIF) technique became more popular because it allowed for a one-sided approach which improved the access to other disk surfaces to do a posterior fusion. The muscles and nerves were still cut in TLIF which caused significant postoperative issues. To address these issues, a minimally-invasive TLIF was developed to decrease blood loss and lower the complication rate, even though the MIS TLIF took longer to perform than the original TLIF. Patient outcomes were similar for both MIS TLIF and traditional open TLIF, however the MIS TLIF was more technically challenging for the surgeon to perform. ALIF The Anterior Lumbar Interbody Fusion (ALIF) approach had several key advantages but involved a major abdominal incision. This technique allowed direct view of the disc space and vertebral bodies which permitted easier clearing of the disc space. The back and lateral muscles were spared in the ALIF which reduced postoperative pain. A consideration was that major organs and blood vessels had to be avoided or moved out of the way. There were significant reasons why some people could not undergo this approach such as prior abdominal surgery or known scar tissue. ALIF also causes retrograde ejaculation in a very small number of male patients (1-2%). However, the complication rates between ALIF and TLIF were similar, including comparable blood collections, wound infections, wound separation, spinal fluid leakage, nerve damage, and non-fusion rates.