P29. A novel surgical approach using the “lateral corridor” for minimally invasive oblique lumbar interbody fusion at L5-S1: a clinical series and technical note

Abstract

BACKGROUND CONTEXT

There are various approach techniques for the interbody fusion of the lumbosacral region (L5-S1), and each method has its own advantages, disadvantages, and clinical features. The minimally invasive oblique lumbar interbody fusion (MI-OLIF) L5-S1 was introduced to overcome the limitations of conventional fusion techniques, however, MI-OLIF is not possible using the standard method due to vascular structures in some cases.

PURPOSE

To introduce the “lateral corridor” as an optional surgical approach for MI-OLIF L5-S1 and report the details of the surgical technique with a clinical case series.

STUDY DESIGN/SETTING

A clinical series and technical note.

PATIENT SAMPLE

Patients who underwent MI-OLIF L5-S1 at our hospital between July 2015 and October 2022 for degenerative lumbar disease were included. Patients with confirmed spinal surgery history within 1 year and those with an infection, tumor, or trauma were excluded. Among the 107 patients who underwent MI-OLIF L5-S1, 26 patients (24.3%) who received the “lateral corridor” technique were included.

OUTCOME MEASURES

The type and frequency of branch vessels that required additional manipulations were reviewed, and the frequency of intraoperative vascular injury was investigated.

METHODS

We propose a novel surgical approach using the “lateral corridor” to access the lateral window to the left common iliac vein (LCIV) in this study as an alternative to the standard technique using the central corridor. The LCIV is manipulated in significantly different ways between the two approaches. The central corridor method uses the medial window of the LCIV and retracts the LCIV and the left common iliac artery laterally. In contrast, the “lateral corridor” method uses the lateral window of the LCIV and retracts all vasculature medially. It is the space between the lateral margin of the LCIV and the medial margin of the left psoas muscle.

RESULTS

We introduced surgical technique using the "lateral corridor" in the following steps: 1) patient position, localization, and skin incision, 2) soft tissue dissection, 3) vascular dissection, 4) intervertebral disc and endplate preparation, 5) cage insertion and orientation, and 6) closure and posterior procedure. Branch vessel ligation was required in 42.3% of the patients. The types of branch vessels that required ligation were seven cases (26.9%) of the iliolumbar vein (ILV) and six cases (23.1%) of the ascending lumbar vein (ALV). The ILV and ALV were ligated in two cases. None of the patients developed intraoperative vascular injuries.

CONCLUSIONS

We introduced the "lateral corridor" as an alternative approach for MI-OLIF L5-S1, implemented it in 24.3% of the patient cohort, and reported favorable outcomes devoid of vascular complications. The “lateral corridor” necessitated ligation of the ILV or ALV in 42.3% of cases. The “lateral corridor” approach appears to be a promising surgical technique, offering feasibility even in instances where the vascular anatomy precludes the employment of the conventional approach.

FDA Device/Drug Status

This abstract does not discuss or include any applicable devices or drugs.