Overview
The OLIF25 approach allows access to the oblique corridor, anterior to the psoas and lumbar plexus and posterior to the great vessels under direct visualization. At the L4-L5 level, this oblique corridor is anterior to the lower part of the iliac crest. This avoids the need to break the operating table, as would be necessary in a transpsoas approach. When compared to a traditional ALIF at the L4-L5 disc space, the OLIF25 approach does not require mobilization of the great vessels.
This approach incorporates a comprehensive set of instruments and implants, including fully integrated neuromonitoring and navigation, streamlined access instrumentation, anatomically favorable implants, and percutaneous fixation systems.
Benefits
Preserves muscle and avoids nerves of the lumbar plexus
In an OLIF25 approach, the retractor is positioned anterior to the psoas, avoiding the nerves inside the muscle. Because of this, intraoperative monitoring may be optional.
Avoids the iliac crest
The iliac crest may block access to the L4-L5 disc space for transpsoas lateral approaches, often necessitating breaking — “jackknifing” — the operating table.
In the OLIF25 approach, the incision is moved approximately 5 cm anterior to the midpoint of the disc (approximately 14° to 20° anterior to direct lateral). The oblique approach facilitates unobstructed clearance to the L4-L5 disc space.
Preoperative planning
Review axial, and sagittal MRI images and AP/lateral X-ray images prior to an OLIF25 procedure. Preoperative planning is important to identify nuances of foundational anatomy before every case. Surgeons should identify the:
- Shape and size of the anterior vasculature
- Size and position of the psoas to understand the width of the oblique corridor
- Location of the iliac crest and lower ribs in relation to disc space of interest
- Coronal and sagittal curvatures of the spine
- Abnormalities of peritoneal content
Patient positioning
Standard transpsoas surgical positioning is lateral decubitus, right or left side up. For the OLIF25 approach, right lateral decubitus (left side up) is preferred because of the usual position of the aorta and vena cava in relation to the oblique corridor. Correction of deformity may be achieved either from the convex or concave side of the curve.
OLIF25™ Surgical Position
Transpsoas Surgical Position
|
|
OLIF25 |
TRANSPSOAS |
|---|---|---|
| Patient Position |
Lateral decubitus (usually left side up) to allow for optimal access via the oblique corridor |
Lateral decubitus (right or left side up) |
| Operating Table |
No breaking of operating table required |
Operating table breaks at patient's iliac crest |
| Hip/Knee Flexion |
Top leg extended and bottom leg slightly flexed |
Hips and knees flexed |
| Surgeon Position |
Anterior to patient |
Posterior to patient |
| C-Arm Position |
Posterior to patient |
Surgeon preference |
Orthogonal maneuver
The orthogonal maneuver shifts the instrumentation from an oblique trajectory to a direct lateral trajectory. This maneuver enables the surgeon to place the cage perpendicularly across the disc space, allowing for the rotation of instruments to reach the contralateral side of the disc space and avoid injury to the contralateral foramen and exiting nerve.
Proper placement of the retractor is critical for this maneuver. Cage rotation will be affected by disc material left in the passage of cage introduction. Take care to remove the disc to facilitate the placement of interbody prosthesis. The final cage placement in an OLIF approach should look identical to that of a traditional transpsoas lateral approach.
NOTE: The Pivox™ Oblique Lateral Spinal System accommodates insertion via the oblique trajectory. This interbody device features an articulating arm that adjusts from 0˚ to 40˚ to keep the instrumentation in the oblique corridor while rotating the cage into a direct lateral final placement. In this case, the orthogonal maneuver is optional.
Potential injuries and complications
The potential risks of injury to anatomical structure include but not limited to:
Learn more about key concepts & anatomy
Brief Summary of Indications for Pivox™ Oblique Lateral Spinal System
Cage:
Use with autograft and/or allogenic bone graft comprised of cancellous and/or corticocancellous bone graft to facilitate interbody fusion; in patients with Degenerative Disc Disease (DDD) at one or two contiguous levels from L2 to S1, with or without up to Grade 1 Spondylolisthesis or retrolisthesis at the involved levels; used with supplemental fixation cleared for use in the lumbar spine; and to provide anterior column support in patients with degenerative scoliosis as an adjunct to pedicle screw fixation.
Plate and Screws Supplemental fixation:
Oblique or lateral L1-L5 above the vascular structures bifurcation; anterior L5-S1 below the bifurcation; Temporary stabilization in patients with DDD; trauma; tumors; deformity; pseudarthrosis; and/or failed previous fusions. Cage with Plates and Screws In patients with DDD at one or two contiguous levels from L2 to S1, with or without up to Grade 1 Spondylolisthesis or retrolisthesis at the involved levels. Device usage is as described in U.S. labeling. Please consult labeling limitations relevant to your geography of clinical practice.