Published online Jun 18, 2021. doi: 10.5312/wjo.v12.i6.445
Peer-review started: February 15, 2021
First decision: May 3, 2021
Revised: May 4, 2021
Accepted: May 27, 2021
Article in press: May 27, 2021
Published online: June 18, 2021
Oblique lumbar interbody fusion is a mini-open retroperitoneal approach that uses a wide corridor between the left psoas muscle and the aorta above L5. This approach avoids the limitations of lateral lumbar interbody fusion, is considered less invasive than anterior lumbar interbody fusion, and is similarly effective for indirect decompression and improving lordosis while maintaining a low comp
Cases of three patients who underwent multilevel oblique lumbar interbody fusion including L5-S1, using one of the three different techniques, are described. All patients presented with symptomatic degenerative lumbar pathology and failed conservative management prior to surgery. The anatomical considerations that affected the decisions to utilize each approach are discussed. The pros and cons of each approach are also discussed. A parasagittal facet line objectively assesses the relationship between the left common iliac vein and the L5-S1 disc and assists in choosing the approach to L5-S1.
Oblique retroperitoneal access to L5-S1 in the lateral decubitus position is possible through three different approaches. The choice of approach to L5-S1 may be individualized based on a patient’s vascular anatomy using preoperative imaging. While most surgeons will rely on their experience and comfort level in choosing the approach, this article elucidates the nuances of each technique.
Core Tip: Oblique lumbar interbody fusion (OLIF) provides safe retroperitoneal access to nearly all lumbar levels, including L5-S1, thus, allowing single-position surgery. L5-S1 OLIF access may be attempted through three alternative approaches — left intra-bifurcation, left pre-psoas and right pre-psoas approaches — the choice of which can be customized according to the patient’s vascular anatomy.