Neuro-navigation assisted pre-psoas minimally invasive oblique lumbar interbody fusion (MI-OLIF): New roads and impediments.

Minimally invasive spine-oblique lumbar interbody fusion (MIS-OLIF) has emerged as a novel anterolateral, retroperitoneal, "pre-psoas" approach for lumbar interbody fusion for degenerative spinal instability, as well as for correction of deformity in patients without severe canal stenosis. In the last decade, the technique has gained popularity owing to several advantages like the minimal blood loss, minimal tissue dissection, preservation of posterior tension bands, better biomechanical strength, provision of mechanical stability to the lumbar spine, and a larger footprint of the implant, associated with it. It, thus, maximises load bearing on the cortical bone, and provides a better lordotic correction of the lumbar spine. The armamentarium is further boosted by the use of neuro-navigation and neuro-monitoring tools, thereby improving the surgical outcome. The clinical indications of MIS-OLIF and various fixation methods [lateral lumbar fixation (LLF) and percutaneous posterior pedicle fixation (PPF)] are discussed. The summary of the 15 patients on whom the technique was utilized, are discussed. The patients' demographics, clinical history and neurological examination data, pre- operative Oswestry disability index (ODI) and visual analogue scale (VAS) score, intraoperative surgical details and postoperative follow up clinical as well as radiological data were assessed. Complications, readmissions, length of stay, estimated blood loss, surgical time and surgical outcome were also recorded. 11 cases had grade 1 spondylolisthesis and 4 had grade 2 spondylolisthesis. One patient had both grade I and II spondylolisthesis at different levels. 13 patients had improvement in mechanical back pain and neurogenic claudication. Two patients had improvement in back pain but one-sided limb radiculopathy persisted, which was treated conservatively. The mean pre-operative ODI score was 35 ± 6.1, which improved to 14.6 ± 4.1 at follow-up (range of follow-up: 1 to 10 months; mean 5.7 ± 3.3 months]. The mean pre-operative VAS score was 7 ± 0.7, which improved to 3.3 ± 0.4 at follow-up. The MIS-OLIF technique at the L2-L5 levels has shown encouraging early surgical outcomes with a good fusion rate and rapid recovery. While utilizing the unfamiliar oblique trajectory, the use of navigation can guide the surgeon in real time and also help in reducing the radiation exposure.

There are no conflicts of interest