Oblique/Lateral Lumbar Interbody Fusion

What is Oblique/Lateral Lumbar Interbody Fusion? 

Oblique/lateral Lumbar Interbody Fusion (OLIF/LLIF) is a type of spinal fusion surgery. This procedure aims to alleviate pain and correct deformities in the lumbar spine by fusing the vertebrae.


OLIF is a minimally invasive procedure conducted from an oblique (angled) approach to the spine. This approach allows the surgeon to access the spine without manipulating or moving the major vessels or nerves, often required in other lumbar surgeries. LLIF is similar, but the approach is directly lateral through the body of the psoas muscle in the lumbar spine. 


Who is Suitable for OLIF/LLIF?

As for suitability, the decision to recommend OLIF/LLIF surgery is made on a case-by-case basis, considering the patient's overall health, the nature of their spine condition, and the failure of conservative treatments.


Potential candidates for OLIF/LLIF may include individuals who have:

  • Chronic low back pain that has not responded to conservative treatments (like physical therapy or medication)
  • Degenerative disc disease (breakdown of discs, which act as cushions between the bones in the spine)
  • Spondylolisthesis (slippage of one vertebral body over another)
  • Lumbar spinal stenosis (narrowing of the spinal canal in the lower back)
  • Lumbar degenerative scoliosis (curvature of the spine due to degeneration)


Benefits of Oblique/Lateral Lumbar Interbody Fusion

  • Minimally Invasive: Since OLIF/LLIF is performed through small incisions, it typically results in less blood loss, less muscle damage, less postoperative pain, and faster recovery compared to traditional open spine surgery.
  • Avoids Major Vessels and Nerves: The oblique approach allows surgeons to avoid important structures like the abdominal aorta, inferior vena cava, and lumbar plexus, reducing the risk of complications related to these structures. The lateral approach has less risk of vessel damage but slightly more risk to the lumbar plexus of nerves and psoas muscle.
  • Restoration of Spinal Alignment and Height: OLIF/LLIF can help restore the natural curvature and height of the spine, which can alleviate pain and improve function.
  • Increased Spinal Stability: By fusing the vertebrae, the spine becomes more stable, alleviating pain and improving spinal function.
  • Increased Fusion Rate: There is a higher fusion rate due to the larger cage size able to be implanted compared with TLIF/PLIF and better preparation of the vertebral endplates. 


Alternative Options to Oblique/Lateral Lumbar Interbody Fusion

Alternatives to OLIF/LLIF would depend on the underlying condition, ranging from conservative management to different surgical procedures.

  • Conservative management: This includes physical therapy, pain medication, epidural steroid injections, lifestyle modifications, and weight loss, among other options. These are usually the first line of treatment before surgical intervention is considered.
  • Lumbar laminectomy or laminotomy: These procedures are designed to relieve pressure on the spinal cord or nerves by removing part or all of the lamina, the bony plate that protects the spinal canal and spinal cord.
  • Posterior Lumbar Interbody Fusion (PLIF) and Transforaminal Lumbar Interbody Fusion (TLIF): These are other types of lumbar fusion surgery accessed from the back (posterior) side of the body.
  • Anterior Lumbar Interbody Fusion (ALIF): This is a similar fusion procedure that, like OLIF, is accessed from the body's front (anterior) side but without the oblique approach.
  • Direct Lateral Interbody Fusion (DLIF) or Extreme Lateral Interbody Fusion (XLIF): These are fusion surgeries that are accessed from the side (lateral) of the body.
  • Disc replacement surgery: In some cases, replacing the problematic disc with an artificial one may be an option.
  • Spinal cord stimulation and pain pumps: These are more advanced options for pain relief when conservative measures fail and if the patient is not a candidate for surgery.


The choice between these options would depend on many factors, including the exact nature of the spinal pathology, the patient's overall health, and the surgeon's expertise.


Preparation for Oblique Lumbar Interbody Fusion

Before Oblique Lumbar Interbody Fusion:

  • Medical Evaluation: Your surgeon will thoroughly evaluate you to ensure you are healthy enough for surgery. This may include blood tests, imaging studies, and other diagnostic tests.
  • Medication Review: Discuss all the medications you are currently taking with your surgeon. Before surgery, you may need to stop taking certain medications, such as blood thinners or NSAIDs.
  • Lifestyle Adjustments: If you smoke, your surgeon will likely advise you to quit, as smoking can delay healing. Maintaining a healthy diet and regular exercise routine can help improve your recovery.
  • Pre-surgical Physiotherapy: Some surgeons recommend a course of physiotherapy to strengthen the back muscles and improve recovery outcomes.
  • Prepare for Recovery: Make sure your home is ready for your return post-surgery. You may need to arrange for assistance with daily activities during your recovery.


Oblique Lumbar Interbody Fusion Procedure

  • Anaesthesia: You will be given general anaesthesia, so you'll be asleep and not feel pain during the procedure.
  • Positioning: Your surgeon and the theatre team will position you on the surgical table, on your side. This often involves taping to ensure your position doesn’t change during the procedure.
  • Intra-operative Imaging: X-rays or CT is used for surgical guidance.
  • Incision: The surgeon makes a small incision in your abdomen on the side, avoiding major blood vessels and nerves.
  • Accessing the Spine: The surgeon uses real-time X-ray guidance to navigate the affected spine area safely.
  • Disc Removal and Preparation: The surgeon removes the degenerated disc and prepares the intervertebral space for the fusion.
  • Insertion of the Fusion Device: A device filled with bone graft material is inserted into the empty disc space, helping to promote alignment correction,  bone growth and eventual fusion of the adjacent vertebrae.
  • Additional Hardware: In some cases, additional hardware like screws and rods may be placed for further stability.
  • Closure: The incision is then closed with sutures.


After Oblique Lumbar Interbody Fusion

Depending on your overall health and the specifics of your surgery, you may need to stay in the hospital for a few days following the procedure. During this period, managing pain and preventing complications is the priority.


Oblique Lumbar Interbody Fusion Recovery Plan

  • Pain management: You will be prescribed pain medications to help manage post-operative pain. It's important to take the medications as directed and communicate with your healthcare team about your pain levels and concerns.
  • Physiotherapy: Physical therapy will likely begin after your medical team clears you. This can involve gentle stretching, walking, and other exercises to improve strength and flexibility.
  • Activity restrictions: Your surgeon will provide specific guidelines regarding activity restrictions and limitations during recovery. Following these instructions is crucial to avoid complications and promote proper healing.
  • Home Care: You'll be discharged home with specific instructions for wound care, medication use, and activity level. You may require assistance at home for daily activities initially.
  • Long-Term Follow-up and Rehabilitation: Regular follow-ups with your surgeon will be crucial to monitor your healing and progress. You may also continue with outpatient physical therapy for weeks or months, gradually increasing your activity level.
  • Lifestyle Modifications: Maintaining a healthy lifestyle, including a balanced diet and regular exercise (as permitted), can facilitate healing. Avoiding smoking, excessive alcohol, and heavy lifting can also aid recovery.


Oblique Lumbar Interbody Fusion Prognosis

The prognosis for OLIF is generally good, with many patients experiencing a significant reduction in pain and improved function. However, the exact prognosis can vary based on factors such as the patient's overall health, the specific condition being treated, the number of spinal levels involved, and the patient's compliance with the postoperative rehabilitation plan.


Oblique Lumbar Interbody Fusion Risks

As with any surgical procedure, OLIF carries potential risks, which can include:

  • Infection
  • Bleeding
  • Blood clots
  • Damage to blood vessels or nerves in and around the spine
  • Complications related to anaesthesia
  • Non-union (the vertebrae do not fuse as intended)
  • Persistent pain
  • Failure to relieve symptoms


What if Oblique Lumbar Interbody Fusion is Delayed?

If the procedure is being performed to relieve chronic pain from conditions such as degenerative disc disease or spondylolisthesis, delaying the surgery could mean continued pain and decreased quality of life for the patient.


In some cases, the underlying spinal condition may worsen over time. For example, a degenerating disc could continue to break down, or a slipped vertebra could slip further. In extreme cases, This could lead to more severe symptoms, including increased pain, weakness, numbness, or even loss of bowel or bladder control.


However, because OLIF is often considered after conservative treatments have failed, a short delay for further conservative management may not significantly change the overall situation. In any case, the decision to delay surgery should always be made in consultation with a qualified spinal surgeon.

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