What is Endo-OLIF procedure?
Endo-OLIF is a combined minimally invasive spinal approach which takes full advantages endoscopic spine surgery, O-arm navigation, and minimally invasive technique for anterior spinal fusion.
The OLIF procedure is an oblique approach intermediary between an anterior lumbar interbody fusion (ALIF)
and a direct lateral lumbar interbody fusion (DLIF)
. Unlike the ALIF procedure, all major blood vessels are avoided in this approach, and unlike the DLIF procedure, psoas muscles and lumbar plexuses are left undisturbed thereby reducing the risk of postoperative pain and neurological/plexus injury. Occasionally, low-lying rib cage or high iliac crest position is found in some people making it impossible with the direct lateral approach (DLIF) to gain access to high lumbar disc spaces (L1/2 and L2/3) or lower lumbar spaces (L4/5 and L5/S1). By contrast, the oblique approach can access most lumbar disc spaces from L1/2 to L4/5 without difficulties, as it is not hindered by the rib cage or the iliac crest.
The Endo-OLIF offers many advantages over traditional lumbar fusion surgery. In older patients, the benefits become much more obvious with less wound pain, less blood loss, and shorter hospital stay. The OLIF implant/cage is wider providing more stability and better support for the anterior spinal column (advantageous in osteoporotic bone). In addition, better correction of lumbar scoliosis and lordosis can be achieved by using larger OLIF implants and by inserting the implant from an oblique/lateral direction (the same direction plane as the scoliotic deformity).
The Endo-OLIF procedure is often used in combination with other minimally invasive posterior procedures, such as endoscopic lumbar decompression and/or percutaneous pedicular screw placement. By combining O-arm navigation and spinal endoscopy with the OLIF procedure, surgical precision and better visualization of important anatomical structures can be achieved, thus increasing overall safety and providing better clinical outcome for patients.
How is it done?
Under general anaesthesia with the patient lying usually on his/her right side, the surgeon makes a small incision on left flank to expose the front part of the spine by going around the back of the abdominal cavity along the back wall without having to go through the abdominal cavity or cut through any of the back muscles. After disc material is endoscopically removed from the front of the spine, a synthetic cage with bone substitute is inserted under O-arm navigation into the empty disc space to support and create lumbar fusion, and at the same time restoring disc height and spinal alignment into its natural lumbar curvature. Surgery usually takes about 1 to 2 hours to perform for a one or two-level procedure.
Why is it done?
Spinal disc degeneration and micro-instability of the lumbar spine can cause mechanical back pain, buttock, groin and hip pain, and nerve root irritations resulting in leg pain. This procedure is designed to stabilize the spine by achieving higher fusion rates to relieve back pain and their associated symptoms, without interfering with nervous tissues thereby avoiding scar formation around nerve roots.
Indications for Endo-OLIF procedure
At our institution, the Endo-OLIF surgery is the procedure of choice for treatment and correction of degenerative lumbar scoliosis.
- Discogenic back pain (single or multiple level)
- Low grade lumbar spondylolisthesis- bone slip
- Spinal instability
- Lumbar spondylosis
- Degenerative disc disease
- Failure of previous posterior lumbar fusion surgery with pseudoarthrosis
- Combined with posterior procedure to enhance bone fusion
Risks and complications
As with any spinal surgery, the risks include:
- Bleeding from blood vessels
- Nerve injury with progression of neurological deficit such as leg pain, weakness and numbness, and urinary and defaecation problems
- Wound Infection
- Complication related to instruments, e.g. malpositioning and subsidence bone grafts and artificial cages
- Blood clot in the legs (deep vein thrombosis), which can dislodge and move to the lungs (pulmonary embolism)
- Anaesthetic complications
Alternatives to spine surgery
- Weight loss
- Back exercises
- Physical therapy and rehabilitation programme
- Hot/cold therapy
- Ultrasound therapy
- Spinal traction
- Epidural steroid injections
- Facet or SI joint block
- Radiofrequency treatment
Bumrungrad International Clinic (BIC) Building , 20th
Bumrungrad International Hospital, Bangkok, Thailand
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