How to Choose Surgical Corridor in Left Oblique Approach Lumbar Interbody Fusion at the L5-S1 Segment: A Prospective Cohort Study

• Published in: World neurosurgery 2024-03, Vol.183, p.e730-e737
• Main Authors: Liu, Fengyu, Liu, Yanbing, Gu, Zhenfang, Zhao, Zhengqi, Gao, Yuan, Lu, Kuan, Sun, Xianze
• Format: Article
• Language: English
• Subjects: Anterior to psoas; L5-S1; Oblique lateral interbody fusion; Oblique-anterior lumbar interbody fusion; Surgical corridor
• ISSN: 1878-8750; 1878-8769; 1878-8769
• DOI: 10.1016/j.wneu.2024.01.016

There are 2 surgical corridors to L5-S1 lumbar interbody fusion via the left oblique approach: anterior to psoas−oblique lateral interbody fusion (ATP-OLIF) and oblique−anterior lumbar interbody fusion (O-ALIF). The aim of this study was to evaluate criteria to guide the selection of surgical corridors for L5-S1 lumbar interbody fusion via the left oblique approach. According to the structure of L5-S1 segment left common iliac vein (LCIV) in axial magnetic resonance image, the LCIV was divided into 6 types. O-ALIF was performed for type I and type II. ATP-OLIF was performed for type A and type B. For sexually active men, ATP-OLIF was chosen. Between April 2020 and April 2022, 22 patients were assigned to ATP-OLIF or O-ALIF based on the type of LCIV. Clinical outcomes and radiographic outcomes were assessed. There were 11 cases in O-ALIF group (type I, n = 10; type II, n = 1) and 11 cases in ATP-OLIF group (type A, n = 8; type B, n = 3). No differences were observed in clinical outcomes (Oswestry Disability Index, VAS, and complication rate); radiographic outcomes (mean disk height and segmental lordosis angle); length of hospital stay; operation time; and blood loss. No vascular injury occurred in either group. This may be an appropriate criterion to guide the selection of surgical corridor for L5-S1 lumbar interbody fusion through the left oblique approach. O-ALIF was performed for type I and type II. ATP-OLIF was performed for type A and type B. For sexually active men, ATP-OLIF was chosen. According to this standard, the operation can be performed safely and with good clinical results.