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Oblique lateral lumbar interbody fusion(L2-5) (OLIF25)

Dr. Joseph MK Lam

Honorary Clinical Assoicate Professor

The Chinese University of Hong Kong

OLIF Anatomy

OLIF25 basic anatomay Demo

6min25S

OLIF25 basic anatomay Demo

Preoperative evaluation

Radiological evaluaton

Saggital and coronal balance

Segment mobility

MRI evaluation

Vascular anatomy

Vascular anatomy

spinal stenosis evaluation

If patient need direct or indirect decompression

spinal stenosis evaluation

DEXA bone density evaluation

DEXA bone density evaluation

Standalone or Screw augmentation

Age >60 yo

Female

Osteoporosis

Spondylolisthesis/Scoliosis

If only one or less factor can have standalone +/- vertebral body screw and plate

If two or more factor consider Pedicle screw / corticle screw +/- cement augmentation

Medical fitness

Cardiopulmonary function

blooding tendancy

Abdominal surgery

Risk of infection

Medical fitness

OLIF25 step by Step

Position

Position

OLIF position

no need to break table

True lateral and AP X-ray

DLIF position

X-ray Position

Wound

Wound

Insertion of retractor

Insertion of retractor

Direct look with lighted retractor

17:13-19:08

Shallow dock over the psoas

see and dissect before insertion of retractor

Shallow dock over the psoas

Disectomy

Disectomy

Insertion of cage

Closing

Closing

Case selection

Contraindications

Contraindication case 1

Contraindication case 1

Contraindication case 2

Contraindication case 2

Contraindication 3

Contraindication 3

Indication

Case demonstration

Indication

Indication case 1

Indication case 1

Indciation case 2

Indciation case 2

Indication case 3

Indication case 3

supplementary stabilization

Cement augmented fenestration pedicle screws

Cement augmented fenestration pedicle screws

Pedicle screws fixation

Pedicle screws fixation

vertebral body screw and plate

vertebral body screw and plate

Corticle screw fixation

Corticle screw fixation

Standalone cage

solid fusion with stand a long cage

solid fusion with stand a long cage

Complication avoidance

Richard Hynes

Complication avoidance

Richard Hynes

Surgical Video

Video demonstration

Richard Hynes

Richard Hynes

OLIF25 surgical video

STORY 2

STORY 2

Complex deformity case

Adult lumbar deformity case

Adult lumbar deformity case

lateral LIF initial 100 case <5 year

lateral LIF initial 100 case <5 year

Type of lateral instrumentation

OLIF 64

OLIF+DLIF 2

OLIF+AXIALIF 1

DLIF 29

Veo 2

XLIF 2

Type of additional posterior fixation

Pedicle screws (bilateral) 51

cement augmented pedicle screws 16

Cortical screw (MLIF) 6

Unilateral pedicle screw 4

Standalone cage(s) 23

Staged surgery

complete in one stage 91

complete in two stages 9

level of lateral lumbar fusion involved

one level 71

two level 28

three level 1

No major complications e.g. intra-abdominal hemorrhage, cage infection, permanent nerve damage.

1 residual nerve compression after indirect decompression need secondary decompression surgery

2 cases cage subsidence without need for surgery (one standalone and one unilateral screw)

Successful decompression with residual lower limb symptoms:

one thoracic myelopathy.

One with concomitant cervical myelopathy.

one with subsequent diagnosis multiple sclerosis.

5 cases of delay adjacent level disease:

2 need decompression surgery

3 need medication or radiofrequency treatment

Overall 95% satisfied with the long term outcome.

Lesson Learnt

Need careful analysis of preoperative images, especially the anatomy of the facet joint and foramen. This is to assess the need for direct decompression.

Always use wider and longest cage to reduce chance of cage subsidence.

Always use bilateral pedicle or cortical screw if there is risk factor for cage subsidence:

age over 60; scoliosis or spondylolisthesis; Female; Osteoporosis.

If in doubt applied pedicle screw fixation

Best position for cage insertion is lateral decubitus

Best position for pedicle or cortical screw fixation is prone position with back at physiological lordosis.

screening of whole spine before complex lumbar spine surgery.

Shifting from DLIF to OLIF except at specific condition.

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