Skip to main content

Advertisement

SpringerLink
Log in

CT-based analysis of oblique lateral interbody fusion from L1 to L5: location of incision, feasibility of safe corridor approach, and influencing factors

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

The primary aim was to measure the safe corridor (SC), surgical incision anterior margin (AM), and posterior margin (PM) for OLIF bilaterally from L1 to L5. The secondary aim was to determine the feasibility of approach via the SC. The tertiary aim was to analyze the influence of demographic and anthropometric factors on OLIF parameters.

Methods

We performed a radiographic analysis of 100 subjects who received an abdominal CT. Measurements of the AM, PM, and SC were obtained as well as patient age, sex, height, weight, and BMI. The intraclass correlation coefficient was used to evaluate interrater reliability. To assess associations among variables, Pearson’s correlation tests and multivariate linear regression models were constructed. Sex differences were analyzed using Student’s t tests.

Results

At L1-2, L2-3, L3-4, and L4-5, the PM was 6.6, 8.2, 9.4, and 10.2 cm on the left side and 7.2, 7.7, 8.8, and 9.5 cm on the right side in relation to the disk space center. The SC was less than 1 cm 1%, 3%,3%, and 18% of the time on the left side, and 15%, 12%,29%, and 60% on the right side. None of the anthropometric factors demonstrated a strong correlation with incision location. SC was larger on the left side. Interrater ICC was .934.

Conclusions

This study is the first to provide guidelines on the appropriate location of the incision line during OLIF based on SC from L1 to L5. SC measurements do not vary by sex. OLIF is more feasible via a left-sided approach.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Availability of data and material

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Wang K, Zhang C, Wu H, Chen Z, Chou D, Jian F (2019) The anatomic characteristics of the retroperitoneal oblique corridor to the L1–S1 intervertebral disc spaces. Spine 44(12):E697–E706

    Article  PubMed  Google Scholar 

  2. Kanemura T, Satake K, Nakashima H et al (2017) Understanding retroperitoneal anatomy for lateral approach spine surgery. Spine Surg Relat Res 1(3):107–120

    Article  PubMed  PubMed Central  Google Scholar 

  3. Quillo-Olvera J, Lin GX, Jo HJ, Kim JS (2018) Complications on minimally invasive oblique lumbar interbody fusion at L2–L5 levels: a review of the literature and surgical strategies. Ann Transl Med 6(6):101

    Article  PubMed  PubMed Central  Google Scholar 

  4. Xiao L, Xu Z, Liu C, Zhao Q, Zhang Y, Xu H (2019) Anatomic relationship between ureter and oblique lateral interbody fusion access: analysis based on contrast-enhanced computed tomographic urography. World Neurosurg 123:e717–e722. https://doi.org/10.1016/j.wneu.2018.12.011

    Article  PubMed  Google Scholar 

  5. Julian Li JX, Mobbs RJ, Phan K (2018) Morphometric MRI imaging study of the corridor for the oblique lumbar interbody fusion technique at L1–L5. World Neurosurg 111:e678–e685. https://doi.org/10.1016/j.wneu.2017.12.136

    Article  PubMed  Google Scholar 

  6. Fujibayashi S, Otsuki B, Kimura H, Tanida S, Masamoto K, Matsuda S (2017) Preoperative assessment of the ureter with dual-phase contrast-enhanced computed tomography for lateral lumbar interbody fusion procedures. J Orthop Sci 22(3):420–424. https://doi.org/10.1016/j.jos.2017.01.009

    Article  PubMed  Google Scholar 

  7. Wang H, Zhang Y, Ma X, Xia X, Lu F, Jiang J (2018) Radiographic study of lumbar sympathetic trunk in oblique lateral interbody fusion surgery. World Neurosurg 116:e380–e385. https://doi.org/10.1016/j.wneu.2018.04.212

    Article  PubMed  Google Scholar 

  8. Wu T, Xiao L, Liu C, Tao X, Xu H (2020) Anatomical study of the lumbar segmental arteries in relation to the oblique lateral interbody fusion approach. World Neurosurg 138:e778–e786. https://doi.org/10.1016/j.wneu.2020.03.080

    Article  PubMed  Google Scholar 

  9. Chen X, Chen J, Zhang F (2019) Imaging anatomic research of oblique lumbar interbody fusion in a chinese population based on magnetic resonance. World Neurosurg 128:e51–e58. https://doi.org/10.1016/j.wneu.2019.03.244

    Article  PubMed  Google Scholar 

  10. Liu L, Liang Y, Zhang H et al (2016) Imaging anatomical research on the operative windows of oblique lumbar interbody fusion. PLoS ONE 11(9):e0163452. https://doi.org/10.1371/journal.pone.0163452

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Parra-Frutos I (2013) Testing homogeneity of variances with unequal sample sizes. Comput Stat 28(3):1269–1297. https://doi.org/10.1007/s00180-012-0353-x

    Article  Google Scholar 

  12. Vetter TR (2017) Fundamentals of research data and variables: the devil is in the details. Anesth Analg 125(4):1375–1380. https://doi.org/10.1213/ANE.0000000000002370

    Article  PubMed  Google Scholar 

  13. Vetter TR (2017) Descriptive statistics: reporting the answers to the 5 basic questions of Who, What, Why, When, Where, and a sixth, so What? Anesth Analg 125(5):1797–1802. https://doi.org/10.1213/ANE.0000000000002471

    Article  PubMed  Google Scholar 

  14. Ratner B (2009) The correlation coefficient: Its values range between +1/−1, or do they? J Target Meas Anal Mark 17(2):139–142. https://doi.org/10.1057/jt.2009.5

    Article  Google Scholar 

  15. Fleiss J (2011) Design and analysis of clinical experiments. Vol 73. Wiley

  16. Shrout PE, Fleiss JL (1979) Intraclass correlations: uses in assessing rater reliability. Psychol Bull 86(2):420–428. https://doi.org/10.1037//0033-2909.86.2.420

    Article  CAS  PubMed  Google Scholar 

  17. Koo TK, Li MY (2016) A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 15(2):155–163. https://doi.org/10.1016/j.jcm.2016.02.012

    Article  PubMed  PubMed Central  Google Scholar 

  18. Molinares DM, Davis TT, Fung DA (2016) Retroperitoneal oblique corridor to the L2–S1 intervertebral discs: an MRI study. J Neurosurg Spine 24(2):248–255. https://doi.org/10.3171/2015.3.SPINE13976

    Article  PubMed  Google Scholar 

  19. Boghani Z, Steele WI, Barber SM et al (2020) Variability in the size of the retroperitoneal oblique corridor: a magnetic resonance imaging-based analysis. Surg Neurol Int 11:54. https://doi.org/10.25259/SNI_438_2019

    Article  PubMed  PubMed Central  Google Scholar 

  20. Wu AM, Tian NF, Wu LJ et al (2013) A radiological and cadaveric study of oblique lumbar interbody fixation in patients with normal spinal anatomy. B Jt J 95-B(7):977–982. https://doi.org/10.1302/0301-620X.95B7.31393

    Article  CAS  Google Scholar 

  21. Davis TT, Hynes RA, Fung DA et al (2014) Retroperitoneal oblique corridor to the L2–S1 intervertebral discs in the lateral position: an anatomic study. J Neurosurg Spine 21(5):785–793. https://doi.org/10.3171/2014.7.SPINE13564

    Article  PubMed  Google Scholar 

  22. Deng D, Liao X, Wu R et al (2022) Surgical safe zones for oblique lumbar interbody fusion of L1–5: a cadaveric study. Clin Anat 35(2):178–185. https://doi.org/10.1002/ca.23804

    Article  PubMed  Google Scholar 

  23. Zhang F, Xu H, Yin B et al (2017) Does right lateral decubitus position change retroperitoneal oblique corridor? A radiographic evaluation from L1 to L5. Eur Spine J 26(3):646–650. https://doi.org/10.1007/s00586-016-4645-7

    Article  PubMed  Google Scholar 

  24. Berry CA (2019) Oblique lumbar interbody fusion in patient with persistent left-sided inferior vena cava: case report and review of literature. World Neurosurg 132:58–62. https://doi.org/10.1016/j.wneu.2019.08.176

    Article  PubMed  Google Scholar 

  25. Yang F, Dou C, Cheng X, Chen B (2021) Oblique lateral interbody fusion to treat lumbar spinal stenosis in a patient with situs inversus totalis: a case report. J Int Med Res 49(7):3000605211032809. https://doi.org/10.1177/03000605211032809

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to thank Elisabeth Clarke for her continual support of our work at the Department of Orthopedic Surgery at Loma Linda University.

Author information

Authors and Affiliations

  1. School of Medicine, Loma Linda University, Loma Linda, CA, USA

    Jacob Razzouk & Gideon Harianja

  2. Twin Cities Spine Center, Minneapolis, MN, USA

    Omar Ramos

  3. University of California Riverside, Riverside, CA, USA

    Shaurya Mehta

  4. Department of Radiology, Loma Linda University Health, Loma Linda, CA, USA

    Nathaniel Wycliffe

  5. Department of Orthopaedic Surgery, Loma Linda University Health, Loma Linda, CA, USA

    Olumide Danisa

  6. Division of Orthopaedics, Jerry L. Pettis VA Medical Center, 25805 Barton Road A106, Loma Linda, CA, 92354, US

    Wayne Cheng

Authors
  1. Jacob Razzouk
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Omar Ramos
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shaurya Mehta
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gideon Harianja
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nathaniel Wycliffe
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Olumide Danisa
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Wayne Cheng
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wayne Cheng.

Ethics declarations

Conflict of interest

The authors received no financial support for the research, authorship, or publication of this article. The authors have no personal, financial, or institutional interest in this article.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 13 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Razzouk, J., Ramos, O., Mehta, S. et al. CT-based analysis of oblique lateral interbody fusion from L1 to L5: location of incision, feasibility of safe corridor approach, and influencing factors. Eur Spine J 32, 1947–1952 (2023). https://doi.org/10.1007/s00586-023-07555-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-023-07555-1

Keywords

Search

Navigation