Faster, Cheaper, Less Blood Loss
Typical OLIF surgeries result in very low amounts of blood loss.
In addition to reduced operative time and disposables costs, due to the ability to perform both the anterior and posterior operations in one session, OLIF can reduce hospital costs in other ways.
After sufficient training, a spine surgeon can perform an OLIF without the help of an access surgeon, as is common in ALIF procedures. A reduction in OR time and time under anesthesia is beneficial to all patients, especially the elderly. Fewer surgical sessions and less invasiveness help to reduce overall length of stay, as well.
Despite data showing similar outcomes at six months and one year, the early improvements and ability to return to work can be the difference between the loss of a career and a short interruption of their usual routine.
Patients who underwent OLIF report lower VAS [Visual Analog Scale] scores shortly after surgery and tend to return to work earlier than those undergoing more invasive approaches.
The literature, according to Dr. Peloza, points out that ODI [Owestry Disability Index] does not include sleep, “When you can’t sleep, that’s the biggest problem with chronic pain,” he said. There is also evidence that patients who have minimally invasive surgery require less opioids after surgery and are less likely to develop opioid dependence. Meaningful outcome measures that are important to patients, and may be more objectively measured, need to be collected. An upcoming study by the Rothman Institute expects to collect sleep scores and use of pain medications, both objective measures of a patient’s post-operative pain. The study may include all minimally invasive approaches or focus on OLIF; it is still being designed.
While there are clear benefits of OLIF, there are still many surgeons worried about learning the new procedure. Knowing some of the potential pitfalls, and how much to worry about them, will be helpful to assuage fears and improve confidence. Dr. John Williams recently described a number of obstacles to OLIF and how to mitigate risk.
Concerns About OLIF
A concern, paramount to many, when approaching the anterior column is avoiding blood vessels. Experienced OLIF surgeons tend not to fear vessels unless calcified and stiff. The aorta and iliac arteries move aside easily, and surgeons can identify tricky vessels ahead of time using preoperative imaging.
Iliac veins that are set wide apart or have a layer of fat between them and the vertebral body are easy to avoid or move. Small vessels can be ligated or electrocauterized to reduce bleeding. Vessels bound by osteophytes often scare away inexperienced surgeons or the access surgeons preparing for an ALIF procedure.
Still, after completing enough straightforward cases, doctors using OLIF can typically avoid the vessels that cannot be moved. While the OLIF is usually performed from the patient’s left side, it can be done from the right depending on the patient’s specific anatomy.
The risk of nerve injury is reduced in OLIF by avoiding the psoas and the lumbar plexus. Rates of retrograde ejaculation are significantly lower than those observed in men undergoing ALIF.
The “orthogonal maneuver” required to rotate a lateral or anterior interbody into position is another difficulty that new surgeons must overcome. However, implants designed specifically for the OLIF procedure solve that issue.
