Preoperative evaluation of left common iliac vein in oblique lateral interbody fusion at L5–S1
- 759 Downloads
Oblique lateral interbody fusion (OLIF) L5–S1 is essentially to perform an anterior lumbar interbody fusion (ALIF) in the lateral position. Because the surgical procedures are performed “obliquely” over the left common iliac vein (LCIV), ensuring that the vein is protected which is particularly important. We aimed to evaluate the configuration of LCIV and its risk of mobilization during anterior approach at L5–S1 segment.
This study involved 65 consecutive patients who underwent anterior lumbar fusion (ALIF, n = 39; OLIF, n = 26) at the L5–S1 segment. Three independent examiners evaluated the configuration of the LCIV at the L5–S1 disc on axial magnetic resonance images of the lumbar spine. The LCIV was categorized into three types according to the difficulty of mobilization: type I (no requirement for mobilization; LCIV runs laterally for more than two-thirds of the length of the left side of the L5–S1 disc), type II (easy mobilization; LCIV obstructs the L5–S1 disc space, but the perivascular adipose tissue is present under the LCIV), and type III (potentially difficult mobilization; no perivascular adipose tissue under the LCIV). The patient records were reviewed for vascular complications.
There were 21 men and 44 women in this study, with a mean age of 63.4 years (range 19–83 years). Type I LCIV configuration was found in 32 (49.2%) patients, type II in 18 (27.7%), and type III in 15 (23.1%). There were 7 (10.8%) patients with LCIV injury (type I, n = 0; type II, n = 2; type III, n = 5) (P = 0.003). Intraobserver reliability for the LCIV classification ranged from substantial to excellent, and interobserver reliability ranged from moderate to excellent.
Preoperative evaluation for anterior approach to the L5–S1 segment should take account of the LCIV position, as well as the difficulty of its mobilization. The type III LCIV configuration showed a high rate of vascular injury.
KeywordsOblique lateral interbody fusion L5–S1 Left common iliac vein Perivascular adipose tissue Magnetic resonance imaging
No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this article.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 3.Hynes R (2014) Oblique lateral interbody fusion (OLIF) technique and complications in 457 levels L1 to S1. In: International Society for the Advancement of Spine SurgeryGoogle Scholar
- 9.Wakita H, Shiga Y, Ohtori S et al (2015) Less invasive corrective surgery using oblique lateral interbody fusion (OLIF) including L5–S1 fusion for severe lumbar kyphoscoliosis due to L4 compression fracture in a patient with Parkinson’s disease: a case report. BMC Res Notes 8:126CrossRefPubMedPubMedCentralGoogle Scholar
- 29.Oikawa Y, Eguchi Y, Watanabe A et al (2017) Anatomical evaluation of lumbar nerves using diffusion tensor imaging and implications of lateral decubitus for lateral transpsoas approach. Eur Spine JGoogle Scholar