John Peloza, M.D.: OLIF is a simple approach without the risks of ALIF or LLIF.
Dr. Peloza claims that OLIF takes the best of the ALIF and LLIF by allowing placement of a large cage and is a simple approach without many of the risks. ALIF is associated with potential blood vessel and nerve damage, as well as requiring an access surgeon to minimize risk to internal organs. LLIF requires transection of the psoas muscle, which can result in weakness and potential post-surgical pain lengthening recovery.
Further, OLIF can access all levels from L1-S1, while lower levels are inaccessible using LLIF because of the iliac crest and ALIF is limited at higher levels by the presence of the aorta and inferior vena cava.
When compared to posterior-only interbody fusion with transforaminal lumbar interbody fusion (TLIF), OLIF is much more reliable and durable. OLIF allows surgeons to implant a larger footprint device, which better promotes fusion than the smaller devices used for TLIF with lower risk of subsidence.
Peloza believes that “TLIF is more of a disease than an operation” and revisions are so routine that he performs several each month. In contrast he has seen few revisions of his OLIF patients.
John Williams, M.D.: OLIF is the natural evolution of MIS spine.
Dr. Williams considers OLIF to be the latest step in the evolution of minimally invasive procedures. He stated that OLIF “moves surgery into a more minimally invasive realm…the goal is to perform the operation with less soft tissue destruction and delivering the implant with less morbidity to the patient.”
Another significant benefit of the OLIF procedure is lower pressure on patient selection. It may be indicated for patients with different pathologies or co-morbidities who would not be candidates for other procedures. Unlike ALIF or LLIF, which may depend on a specific patient’s anatomy, the location of the bifurcation of the aorta into the iliac arteries is not a concern to surgeons experienced in performing OLIF.
The only considerations are chronic inflammatory conditions such as ulcerative colitis, and Crohn’s disease that make anterior based surgeries riskier. Extensive prior surgery, such as that for cancer, may also be a contraindication due to potential loss of retroperitoneal space. There are few anatomical limitations to performing OLIF. Additionally, OLIF is well suited for obese patients. Due to the lateral positioning, much of the excess fat is pulled away from the surgical site by gravity, minimizing the risk of complications that often arise during surgeries performed in supine or prone positions on large patients.
A common hesitation of surgeons learning the procedure is concern over vascular injury due to the proximity of the iliac vessels. While the actual risk of damaging a vessel is low, a benefit of the oblique approach is the ability to rapidly access the surgical site through a larger incision if an OR emergency occurs. Because the surgical corridor is relatively far from organs or muscle a problem can be quickly rectified.
