"Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has."

Margaret Mead
Original article
peer-reviewed

Minimally Invasive Scoliosis Surgery with Oblique Lateral Lumbar Interbody Fusion: Single Surgeon Feasibility Study



Abstract

Background

Degenerative deformities of the spine have traditionally been treated with extensive open surgeries. However, these open procedures are associated with a high degree of surgical morbidity. In this study, we explore whether clinical improvement in patients with spinal deformities can be achieved using a new minimally invasive surgery (MIS) called oblique lateral lumbar interbody fusion (OLLIF). OLLIF is a MIS single surgeon procedure in which the disc is approached through Kambin’s triangle. OLLIF can achieve correction of spinal deformities through careful cage placement.

Purpose

The purpose of this study is to establish the safety and efficacy of using OLLIF to correct spinal deformities and to collect early outcome data. Collected data includes perioperative outcomes, patient reported outcomes, and radiographic outcomes.

Study design/setting

This study is a retrospective review of 37 OLLIF surgeries in 36 patients with symptomatic degenerative spinal deformity. Collected perioperative data included surgery time, blood loss, and hospital stay. Follow-up was conducted at least 150 days post surgery. We recorded complications and patient reported outcomes such as Oswestry Disability Index (ODI) and pain scale. Imaging was conducted pre- and post-surgery. Fusion rates and changes in Cobb angle were also measured.

Results

A total of 37 surgeries that treated 100 vertebral levels were performed. For two and three level procedures, respectively, the mean blood loss was 83 and 178 ml, the average surgery time was 74 and 158 minutes and the average hospital stay was 2.6 and 3.3 days. The patients ambulated within 24 hours in all but two cases. The patients reported pain improvements on the ten-point pain scale from 8.3 to 3.7 (p<0.001) and on the ODI from 53% to 32%. Cobb angles decreased from 16° to 9.3° (p<0.001), amounting to 2.5° of correction per level of surgery. Detailed imaging was reviewed by independent radiologists for 24 cases and 100% interbody fusion was achieved along with 71% right posterolateral and 74% left posterolateral fusion. There were three cases of mild nerve irritation/neuropraxia and no infections.

Conclusions

OLLIF is a safe and effective MIS technique to correct adult degenerative scoliosis. Unlike alternative procedures, OLLIF is technically less complex than comparable procedures and can safely be used from the thoracolumbar junction to S1.



Want to read more?

Create a free account to continue reading this article.

Already a member? Login.



Original article
peer-reviewed

Minimally Invasive Scoliosis Surgery with Oblique Lateral Lumbar Interbody Fusion: Single Surgeon Feasibility Study


Author Information

Hamid Abbasi

Tristate Brain and Spine Institute

Lynn Miller

Minnesota Disc Replacement and Spine Restoration Center

Ali Abbasi Corresponding Author

Pritzker School of Medicine, The University of Chicago Medicine

Vali Orandi

Vascular and Interventional Radiology, Lake Region Healthcare

Kamran Khaghany

Radiology, Lakes Regional Healthcare


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Pearl IRB issued approval. Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared the following conflicts of interest: Financial relationships: Ali Abbasi declare(s) Consulting from Inspired Spine. Hamid Abbasi declare(s) a grant and Consulting, Research from Zyga Technology. Hamid Abbasi declare(s) a grant and Consulting, Research from AMW, LLC. Hamid Abbasi declare(s) (past) Consulting, (past) Ownership in distribution from Amendia.

Acknowledgements

Thank you to Kristy Nohl, RN for research data and radiologist imaging collection support.


Original article
peer-reviewed

Minimally Invasive Scoliosis Surgery with Oblique Lateral Lumbar Interbody Fusion: Single Surgeon Feasibility Study


Figures etc.

Share
Original article
peer-reviewed

Minimally Invasive Scoliosis Surgery with Oblique Lateral Lumbar Interbody Fusion: Single Surgeon Feasibility Study

  • Author Information
    Hamid Abbasi

    Tristate Brain and Spine Institute

    Lynn Miller

    Minnesota Disc Replacement and Spine Restoration Center

    Ali Abbasi Corresponding Author

    Pritzker School of Medicine, The University of Chicago Medicine

    Vali Orandi

    Vascular and Interventional Radiology, Lake Region Healthcare

    Kamran Khaghany

    Radiology, Lakes Regional Healthcare


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Pearl IRB issued approval. Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared the following conflicts of interest: Financial relationships: Ali Abbasi declare(s) Consulting from Inspired Spine. Hamid Abbasi declare(s) a grant and Consulting, Research from Zyga Technology. Hamid Abbasi declare(s) a grant and Consulting, Research from AMW, LLC. Hamid Abbasi declare(s) (past) Consulting, (past) Ownership in distribution from Amendia.

    Acknowledgements

    Thank you to Kristy Nohl, RN for research data and radiologist imaging collection support.


    Article Information

    Published: June 25, 2017

    DOI

    10.7759/cureus.1389

    Cite this article as:

    Abbasi H, Miller L, Abbasi A, et al. (June 25, 2017) Minimally Invasive Scoliosis Surgery with Oblique Lateral Lumbar Interbody Fusion: Single Surgeon Feasibility Study. Cureus 9(6): e1389. doi:10.7759/cureus.1389

    Publication history

    Received by Cureus: June 06, 2017
    Peer review began: June 13, 2017
    Peer review concluded: June 22, 2017
    Published: June 25, 2017

    Copyright

    © Copyright 2017
    Abbasi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Background

Degenerative deformities of the spine have traditionally been treated with extensive open surgeries. However, these open procedures are associated with a high degree of surgical morbidity. In this study, we explore whether clinical improvement in patients with spinal deformities can be achieved using a new minimally invasive surgery (MIS) called oblique lateral lumbar interbody fusion (OLLIF). OLLIF is a MIS single surgeon procedure in which the disc is approached through Kambin’s triangle. OLLIF can achieve correction of spinal deformities through careful cage placement.

Purpose

The purpose of this study is to establish the safety and efficacy of using OLLIF to correct spinal deformities and to collect early outcome data. Collected data includes perioperative outcomes, patient reported outcomes, and radiographic outcomes.

Study design/setting

This study is a retrospective review of 37 OLLIF surgeries in 36 patients with symptomatic degenerative spinal deformity. Collected perioperative data included surgery time, blood loss, and hospital stay. Follow-up was conducted at least 150 days post surgery. We recorded complications and patient reported outcomes such as Oswestry Disability Index (ODI) and pain scale. Imaging was conducted pre- and post-surgery. Fusion rates and changes in Cobb angle were also measured.

Results

A total of 37 surgeries that treated 100 vertebral levels were performed. For two and three level procedures, respectively, the mean blood loss was 83 and 178 ml, the average surgery time was 74 and 158 minutes and the average hospital stay was 2.6 and 3.3 days. The patients ambulated within 24 hours in all but two cases. The patients reported pain improvements on the ten-point pain scale from 8.3 to 3.7 (p<0.001) and on the ODI from 53% to 32%. Cobb angles decreased from 16° to 9.3° (p<0.001), amounting to 2.5° of correction per level of surgery. Detailed imaging was reviewed by independent radiologists for 24 cases and 100% interbody fusion was achieved along with 71% right posterolateral and 74% left posterolateral fusion. There were three cases of mild nerve irritation/neuropraxia and no infections.

Conclusions

OLLIF is a safe and effective MIS technique to correct adult degenerative scoliosis. Unlike alternative procedures, OLLIF is technically less complex than comparable procedures and can safely be used from the thoracolumbar junction to S1.



Want to read more?

Create a free account to continue reading this article.

Already a member? Login.



Hamid Abbasi

Tristate Brain and Spine Institute

Lynn Miller

Minnesota Disc Replacement and Spine Restoration Center

Ali Abbasi, M.Sc., Medical Student

Pritzker School of Medicine, The University of Chicago Medicine

For correspondence:
alibenjamin.abbasi@gmail.com

Vali Orandi

Vascular and Interventional Radiology, Lake Region Healthcare

Kamran Khaghany

Radiology, Lakes Regional Healthcare

Hamid Abbasi

Tristate Brain and Spine Institute

Lynn Miller

Minnesota Disc Replacement and Spine Restoration Center

Ali Abbasi, M.Sc., Medical Student

Pritzker School of Medicine, The University of Chicago Medicine

For correspondence:
alibenjamin.abbasi@gmail.com

Vali Orandi

Vascular and Interventional Radiology, Lake Region Healthcare

Kamran Khaghany

Radiology, Lakes Regional Healthcare