What is it about?
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 complication profile. Including L5-S1, when required, adds to these advantages, as this allows single-position surgery. However, variations in vascular anatomy can affect the ease of access to the L5-S1 disc. The nuances of three different oblique anterolateral techniques to access L5-S1 for interbody fusion, namely, left-sided intra-bifurcation, left-sided pre-psoas, and right-sided pre-psoas approaches, are illustrated using three representative case studies.
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Why is it important?
Oblique access to L5-S1 is not as straightforward as that for levels above L5. Variations in vascular anatomy create unique situations for which approaches may need to be customized. Oblique anterolateral approaches to L5-S1 have been described in previous studies as staying lateral to, or approaching between the bifurcated common iliac vessels. These variations of technique have been found to be safe and feasible in individual studies. However, these studies have not provided adequate guidance regarding the choice of approach. Careful assessment of the vascular anatomy is critical as vascular injuries range from 0.3%-4.3%, especially when L5-S1 is included. Three representative case studies are presented to describe how the three previously described variations of approaches can be potentially customized based on a patient’s anatomy.
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This page is a summary of: Nuances of oblique lumbar interbody fusion at L5-S1: Three case reports, World Journal of Orthopedics, June 2021, Baishideng Publishing Group Co., Limited (formerly WJG Press),
DOI: 10.5312/wjo.v12.i6.445.
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