Advances in research on complications of oblique lateral interbody fusion

Abstract

Oblique lateral interbody fusion (OLIF) surgery uses the retroperitoneal gap between the abdominal aorta and left psoas as the surgical approach to perform discectomy and interbody fusion. It has the advantages of shorter operation duration and hospital stay, less blood loss, lighter postoperative pain and quicker recovery compared with traditional lumbar interbody fusion surgery. OLIF surgery has been gradually applied in treating degenerative diseases of the lumbar spine. However, the complications, such as the injury of blood vessels, sympathetic nerves, lumbosacral plexus, peritoneum and ureteral, cannot be negligible. Previous studies reported that the overall incidence of complications about OLIF surgery was 3% to 53.1% with an average of 15.5%, which can be divided into intraoperative and postoperative complications. The incidence of iliac vascular injury was found to be 0.3%-15.4% in OLIF at the L5S1 segments. The anatomy about vascular in this area is complex because the aorta is branched into the left and right iliac artery. The surgical approach in L5S1 segments is also different from the traditional OLIF but similar to the lateral anterior lumbar interbody fusion, which could increase the risk of vascular injury. The other complications which do not show significant segmental difference were based on the previous literatures. The incidence of abdominal aortic injury is 0.1%, which is related to direct damage caused by the narrow operation window of OLIF. The incidence of lumbar segmental arterial injury was 0.7% to 5%, which may be caused by the anatomical variation of L4, 5 lumbar segmental artery. The incidence of lumbar sympathetic nerve injury is 1.7%. More attention should be paid to protect the lumbar sympathetic trunk which lying in the front of the psoas muscle. The incidence of cage-related complications ranges from 2.9% to 13.4%, which perhaps is associated with older age, osteoporosis and use of large-sized cages. Although the incidence of ureteral injury is 0.3% to 1.6%, care should also be taken due to not obvious injury without urinary tube.