In previous studies, Dr. Abbasi compared several traditional surgical treatments of degenerative disc and spine disease. These studies included posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF) and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF), a recent innovation in MI spinal fusion, and oblique lateral lumbar interbody fusion (OLLIF). The study provides significant evidence that OLLIF can be safely employed to treat vertebral levels from T12 to S1 without requiring a large opening. In many cases that require surgery, OLLIF should be considered the preferred treatment method due to the significant benefits it delivers to the patient, including reduced surgery time, shortened hospital stay, and less blood loss.
All patients in the study underwent a full course of conservative therapy before being considered candidates for surgery. Conservative therapy included physical therapy, therapeutic injections, bracing and behavioral modification. Preoperative imaging included magnetic resonance imaging, X-Ray of the lumbar spine with flexion and extension and, in many cases, a discogram and computed tomography (CT) scan. OLLIF is indicated for severe degenerative disc disease, spondylolisthesis, spinal stenosis and disc herniation. The following anatomical factors were relative contraindications for OLLIF: bony obstruction, significant spinal canal stenosis, large facet hypertrophy and grade II listhesis. Grade II spondylolisthesis is also technically more challenging, but can effectively be treated with the MIS-DLIF technique. OLLIF has been used to correct scoliosis, but for this study, we excluded any patients with Cobb angles > 10 degrees.
Patients were on average 58 ± 16 years old. More than half of all patients were obese, as 80 (26.5 percent) patients had Class I obesity, 54 (17.9 percent) patients had Class II obesity, and 33 (10.9 percent) patients had Class III obesity. The most common surgical level was L4–L5 with 70 percent of the procedures treating this level, followed by L5–S1 which was treated in 50.2 percent of the procedures. The most common preoperative diagnoses were degenerative disc disease (72.3 percent of patients), herniated disc (35 percent), and spondylolisthesis (33 percent).
For a single-level OLLIF, mean surgery time was 52 ± 18.9 minutes, with a blood loss of 42.2 ± 31.1 mL, 198.8 ± 87.2 seconds of fluoroscopy time and a hospital stay of 2.2 ± 1.7 days. Linear regression shows that controlling for the number of levels, there is no significant impact of BMI on surgery time (OLS coefficient 0.23, 95 percent CI -0.15 to 0.61) and that each additional level of surgery increases surgery time by 24.9 (95 percent CI 21.72 to 28.10) minutes.
The findings of this study are being released as a large population of the United States is affected by a recent trend of dramatic increases in degenerative spine diseases leading to disability. This increase is paired with the demand for surgical advances, resulting in skyrocketing associated costs.
Inspired Spine is a Minnesota-based, total spine health company, that offers procedures that optimize the way lumbar fusions are performed. Our methods result in less recovery time, less blood loss, and a procedure time as low as 40 minutes. To date, Inspired Spine surgeons have performed almost 1,000 OLLIF procedures to successfully treat many lumbar spine conditions.