Does the hip positioning matter for oblique lumbar interbody fusion approach? A morphometric study



To evaluate whether left hip positioning widened the access corridor using oblique lateral interbody fusion (OLIF) approach during right lateral decubitus (RLD).


Ten healthy adult volunteers underwent a T2 lumbosacral MRI (1.5 T) in the supine position, RLD position with left hip in extension and then in flexion. L2–L3 to L5–S1 disc spaces were identified. At each level, left psoas surface (in cm2), access corridor (in mm) and vessel movement were calculated in the three positions. Paired t test was used for comparison.


The mean surface of the left psoas ranged from 7.83 to 17.19 cm2 in the three positions (p > 0.05). From L2–3 to L4–5, in RLD, when the left hip shifted from extension to flexion, nor the access corridor nor vessel movements were significantly different. When the volunteers shifted from supine to RLD position with hip in extension, arteries moved 3.66–5.61 mm to the right (p < 0.05 at L2–3, L3–4 and L5–S1), while the venous structures moved 0.92–4.96 mm (p < 0.05 at L2–3) to the right. When the position shifted from supine to RLD with hip in flexion, the arterial structures moved 0.47–4.88 mm (p < 0.05 at L2–3 and L3–4) to the right, while the venous structures moved − 0.94 to 4.13 mm (p < 0.05 at L2–3 and L3–4) to the right.


Hip positioning was not associated with a significant widening of the surgical corridor. To perform OLIF, we advocate for RLD position with left hip in extension to move away the vascular structures and reduce the psoas volume.

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  1. 1.

    Kaiser MG, Eck JC, Groff MW, Watters WC 3rd, Dailey AT, Resnick DK, Choudhri TF, Sharan A, Wang JC, Mummaneni PV, Dhall SS, Ghogawala Z (2014) Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 1: introduction and methodology. J Neurosurg Spine 21:2–6.

    Article  PubMed  Google Scholar 

  2. 2.

    Mobbs RJ, Phan K, Malham G, Seex K, Rao PJ (2015) Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF. J Spine Surg 1:2–18.

    Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Davis TT, Hynes RA, Fung DA, Spann SW, MacMillan M, Kwon B, Liu J, Acosta F, Drochner TE (2014) Retroperitoneal oblique corridor to the L2–S1 intervertebral discs in the lateral position: an anatomic study. J Neurosurg Spine 21:785–793.

    Article  PubMed  Google Scholar 

  4. 4.

    Molinares DM, Davis TT, Fung DA (2016) Retroperitoneal oblique corridor to the L2–S1 intervertebral discs: an MRI study. J Neurosurg Spine 24:248–255.

    Article  PubMed  Google Scholar 

  5. 5.

    Assaker R (2004) Minimal access spinal technologies: state-of-the-art, indications, and techniques. Joint Bone Spine 71:459–469.

    Article  PubMed  Google Scholar 

  6. 6.

    Xu DS, Walker CT, Godzik J, Turner JD, Smith W, Uribe JS (2018) Minimally invasive anterior, lateral, and oblique lumbar interbody fusion: a literature review. Ann Transl Med 6:104.

    Article  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Mayer HM (1997) A new microsurgical technique for minimally invasive anterior lumbar interbody fusion. Spine (Phila Pa 1976) 22:691–699 (discussion 700)

    CAS  Article  Google Scholar 

  8. 8.

    Fujibayashi S, Hynes RA, Otsuki B, Kimura H, Takemoto M, Matsuda S (2015) Effect of indirect neural decompression through oblique lateral interbody fusion for degenerative lumbar disease. Spine (Phila Pa 1976) 40:E175–182.

    Article  Google Scholar 

  9. 9.

    DiGiorgio AM, Edwards CS, Virk MS, Mummaneni PV, Chou D (2017) Stereotactic navigation for the prepsoas oblique lateral lumbar interbody fusion: technical note and case series. Neurosurg Focus 43:E14.

    Article  PubMed  Google Scholar 

  10. 10.

    Woods KR, Billys JB, Hynes RA (2017) Technical description of oblique lateral interbody fusion at L1–L5 (OLIF25) and at L5–S1 (OLIF51) and evaluation of complication and fusion rates. Spine J 17:545–553.

    Article  PubMed  Google Scholar 

  11. 11.

    Silvestre C, Mac-Thiong JM, Hilmi R, Roussouly P (2012) Complications and morbidities of mini-open anterior retroperitoneal lumbar interbody fusion: oblique lumbar interbody fusion in 179 patients. Asian Spine J 6:89–97.

    Article  PubMed  PubMed Central  Google Scholar 

  12. 12.

    Phan K, Mobbs RJ (2015) Oblique lumbar interbody fusion for revision of non-union following prior posterior surgery: a case report. Orthop Surg 7:364–367.

    Article  PubMed  PubMed Central  Google Scholar 

  13. 13.

    Phan K, Maharaj M, Assem Y, Mobbs RJ (2016) Review of early clinical results and complications associated with oblique lumbar interbody fusion (OLIF). J Clin Neurosci 31:23–29.

    Article  PubMed  Google Scholar 

  14. 14.

    Ohtori S, Mannoji C, Orita S, Yamauchi K, Eguchi Y, Ochiai N, Kishida S, Kuniyoshi K, Aoki Y, Nakamura J, Ishikawa T, Miyagi M, Kamoda H, Suzuki M, Kubota G, Sakuma Y, Oikawa Y, Inage K, Sainoh T, Sato J, Shiga Y, Abe K, Fujimoto K, Kanamoto H, Toyone T, Inoue G, Takahashi K (2015) Mini-open anterior retroperitoneal lumbar interbody fusion: oblique lateral interbody fusion for degenerated lumbar spinal kyphoscoliosis. Asian Spine J 9:565–572.

    Article  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Berjano P, Langella F, Damilano M, Pejrona M, Buric J, Ismael M, Villafane JH, Lamartina C (2015) Fusion rate following extreme lateral lumbar interbody fusion. Eur Spine J 24(Suppl 3):369–371.

    Article  PubMed  Google Scholar 

  16. 16.

    Rodgers WB, Gerber EJ, Patterson J (2011) Intraoperative and early postoperative complications in extreme lateral interbody fusion: an analysis of 600 cases. Spine (Phila Pa 1976) 36:26–32.

    Article  Google Scholar 

  17. 17.

    Knight RQ, Schwaegler P, Hanscom D, Roh J (2009) Direct lateral lumbar interbody fusion for degenerative conditions: early complication profile. J Spinal Disord Tech 22:34–37.

    Article  PubMed  Google Scholar 

  18. 18.

    Cummock MD, Vanni S, Levi AD, Yu Y, Wang MY (2011) An analysis of postoperative thigh symptoms after minimally invasive transpsoas lumbar interbody fusion. J Neurosurg Spine 15:11–18.

    Article  PubMed  Google Scholar 

  19. 19.

    Dakwar E, Le TV, Baaj AA, Le AX, Smith WD, Akbarnia BA, Uribe JS (2011) Abdominal wall paresis as a complication of minimally invasive lateral transpsoas interbody fusion. Neurosurg Focus 31:E18.

    Article  PubMed  Google Scholar 

  20. 20.

    Deukmedjian AR, Le TV, Dakwar E, Martinez CR, Uribe JS (2012) Movement of abdominal structures on magnetic resonance imaging during positioning changes related to lateral lumbar spine surgery: a morphometric study: clinical article. J Neurosurg Spine 16:615–623.

    Article  PubMed  Google Scholar 

  21. 21.

    Hu WK, He SS, Zhang SC, Liu YB, Li M, Hou TS, Ma XL, Wang J (2011) An MRI study of psoas major and abdominal large vessels with respect to the X/DLIF approach. Eur Spine J 20:557–562.

    Article  PubMed  Google Scholar 

  22. 22.

    Oikawa Y, Eguchi Y, Watanabe A, Orita S, Yamauchi K, Suzuki M, Sakuma Y, Kubota G, Inage K, Sainoh T, Sato J, Fujimoto K, Koda M, Furuya T, Matsumoto K, Masuda Y, Aoki Y, Takahashi K, Ohtori S (2017) Anatomical evaluation of lumbar nerves using diffusion tensor imaging and implications of lateral decubitus for lateral transpsoas approach. Eur Spine J 26:2804–2810.

    Article  PubMed  Google Scholar 

  23. 23.

    Park DK, Lee MJ, Lin EL, Singh K, An HS, Phillips FM (2010) The relationship of intrapsoas nerves during a transpsoas approach to the lumbar spine: anatomic study. J Spinal Disord Tech 23:223–228.

    Article  PubMed  Google Scholar 

  24. 24.

    O'Brien J, Haines C, Dooley ZA, Turner AW, Jackson D (2014) Femoral nerve strain at L4–L5 is minimized by hip flexion and increased by table break when performing lateral interbody fusion. Spine (Phila Pa 1976) 39:33–38.

    Article  Google Scholar 

  25. 25.

    Davis TT, Bae HW, Mok JM, Rasouli A, Delamarter RB (2011) Lumbar plexus anatomy within the psoas muscle: implications for the transpsoas lateral approach to the L4–L5 disc. J Bone Joint Surg Am 93:1482–1487.

    Article  PubMed  Google Scholar 

  26. 26.

    Guerin P, Obeid I, Gille O, Bourghli A, Luc S, Pointillart V, Cursolle JC, Vital JM (2011) Safe working zones using the minimally invasive lateral retroperitoneal transpsoas approach: a morphometric study. Surg Radiol Anat 33:665–671.

    Article  PubMed  Google Scholar 

  27. 27.

    Baniel J, Foster RS, Donohue JP (1995) Surgical anatomy of the lumbar vessels: implications for retroperitoneal surgery. J Urol 153:1422–1425

    CAS  Article  Google Scholar 

  28. 28.

    Mirilas P, Skandalakis JE (2010) Surgical anatomy of the retroperitoneal spaces, part III: retroperitoneal blood vessels and lymphatics. Am Surg 76:139–144

    PubMed  Google Scholar 

  29. 29.

    Mirilas P, Skandalakis JE (2010) Surgical anatomy of the retroperitoneal spaces, part V: surgical applications and complications. Am Surg 76:358–364

    PubMed  Google Scholar 

  30. 30.

    Lolis E, Panagouli E, Venieratos D (2011) Study of the ascending lumbar and iliolumbar veins: surgical anatomy, clinical implications and review of the literature. Ann Anat 193:516–529.

    Article  PubMed  Google Scholar 

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We acknowledge Benoit DERRE for his technical help when performing MRI for the volunteers.

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Correspondence to Kaissar Farah.

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Farah, K., Leroy, HA., Karnoub, MA. et al. Does the hip positioning matter for oblique lumbar interbody fusion approach? A morphometric study. Eur Spine J 29, 306–313 (2020).

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  • OLIF
  • MRI
  • Hip positioning
  • Psoas
  • Abdominal vessels