Advice for First-Timers and Finding a Solution for the “orthogonal maneuver”
When asked what they would say to surgeons considering preforming OLIF, but still lacking confidence Dr. Williams suggest finding someone doing the surgery now and scrub in to see a few cases and watch an experienced surgeon wrestle through different situations. “I scrubbed into surgery with Dr. Richard Hynes, in Melbourne, Florida, and then Dr. Scott Spann in Austin, Texas. I really picked up a lot of tricks that way,” says Dr. Williams of his experience learning how to do the OLIF procedure.
A complaint of surgeons who have been performing OLIF has been the need for the “orthogonal maneuver” to position interbody devices designed for lateral or anterior approaches.
Cleared in 2019, the Camber Spine SPIRA®-O was designed specifically for the oblique approach. The SPIRA®-O is made of 3D printed titanium arches with a solid titanium corner to help distract the endplates during insertion. The implant is designed to be inserted at a 25o angle from lateral. The lordosis of the implant aligns with the lordosis of the spine and eliminates the need for an orthogonal maneuver, which is required when using implants designed for ALIF or LLIF. Camber Spine is based in King of Prussia, Pennsylvania.
The company states that the open architecture of the device is intended to promote osseointegration, and for the arches to allow for even load distribution across the endplates. This load distribution should not only reduce adverse events such as subsidence, but should also encourage bone growth through mechanotransduction, a tenet of Wolff’s Law.
In addition, surface texture is designed to provide an ideal cellular microenvironment for cell differentiation and proliferation. Dr. Williams explained that with the SPIRA®-O, Camber Spine is “delivering a true open ALIF sized implant through a minimally invasive exposure.” The large footprint of the SPIRA®-O is complemented by surface area in contact with bone, up to a touted 40 points of contact with the endplates.
Camber Spine is expected to produce a purpose designed instrument set and retractor to further simplify the procedure, with an expected release later in 2020. Mindy Elgart, company marketing director, says that Camber Spine plans to host cadaver training courses every 60 days at both their home office in Pennsylvania and Dallas, Texas starting in May.
In addition, one day preceptorships will be facilitated at multiple locations across the country. Of Camber Spine, Dr. Williams believes that the company’s commitment to training sets them apart from other companies. He is one of several, along with Dr. Peloza, who are part of an advisory board to provide input to make the OLIF implant and instruments surgeon-friendly and accessible. Elgart said that several training sessions that had been scheduled for the spring have been cancelled due to travel restrictions, but they are using this time to continue instrument design and development and to plan the roll out during fall conferences.
Dr. Williams sees a strong future for the procedure stating, “I anticipate [oblique lumbar interbody fusion] becoming, if not the standard of care, a procedure that surgeons will consider a standard of care for addressing anterior pathologies. It’s just too slick. Once you have it dialed in it is very safe, there are fewer complications, and patients are getting up and moving faster. There are multiple advantages of this procedure over traditional ways of doing [lumbar fusions].”
