OLIF51 OLIF PROCEDURES

The OLIF51™ procedure offers a laterally-positioned, traditional ALIF retroperitoneal approach to the L5-S1 levels.
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OVERVIEW

OLIF25™ and OLIF51™ procedures are two distinct procedures. The OLIF51 approach is essentially a laterally-positioned, retroperitoneal anterior lumbar interbody fusion (ALIF) approach.

Like a traditional ALIF, the L5-S1 disc space is accessed below the bifurcation of the common iliac vessels, but does not require translation of these major vessels. Since the peritoneum moves away from the oblique corridor , OLIF51 requires less dissection of the retroperitoneal space and can be done with a smaller incision than an ALIF. Like an ALIF, an access surgeon with experience in trans-abdominal and retroperitoneal L5-S1 ALIF procedures is recommended.

BENEFITS

WEIGHT FALLS FORWARD

The anatomical benefit of laterally positioned patients is that the entire peritoneal contents fall away from the oblique corridor with gravity, creating a natural retraction. Like a traditional supine ALIF, the disc space is accessed between the bifurcation of the common iliac vessels. Unlike a supine ALIF, the retractor is under less stress over the duration of the procedure because much of the peritoneal contents have been displaced in an OLIF51.

Anatomical x-ray of OLIF51 positioning

INCISION OUTSIDE THE RECTUS

The OLIF51 approach avoids dissection through the rectus muscle. Unlike traditional ALIF procedures, the superior hypogastric sympathetic plexus is less likely to be disrupted because the OLIF51 procedure is lateral and does not require a midline approach.

Visual of the OLIF51 incision placement

NO PATIENT REPOSITIONING FROM L2 TO S1

The OLIF51 and OLIF25 procedures provide access from L2-S1 in a single position without the need to reposition the patient.

Medtronic minimally invasive spinal surgery

PREOPERATIVE PLANNING

Review axial and coronal MRI images prior to an OLIF51 procedure. Preoperative planning is important for identifying nuances of foundational anatomy before every case. Surgeons should identify:

  • Location of aortic bifurcation
  • Confluence of vena cava
  • Left common iliac artery and vein

PATIENT POSITIONING

Standard ALIF surgical positioning is supine. For the OLIF51 procedure, right lateral decubitus (left side up) position is preferred to enable single-position access to multiple levels L2-S1. For L2-5, because of the usual location of great vessels, a left-sided approach is more accessible.

However, ease of access, surgeon preference, and the preoperative images should be considered in determining which side to approach. Correction can be achieved equally from either the convex or concave side of the curve.

Patient lying in the OLIF25 surgical position
Patient lying in the ALIF surgical position

 

OLIF51 

 ALIF

Patient Position

Right lateral decubitus (left side up) to allow for optimal access via the oblique corridor

Supine

Operating Table

No breaking of operating table required

No breaking of operating table required

Hip/Knee Flexion

Position the patient laterally with the upper hip extended, not flexed, with support under the waist. Failure to extend the upper hip could hinder retractor placement.

Legs straight

Surgeon Position

Anterior to patient

 Lateral to patient

C-Arm Position

Posterior to patient

Lateral to patient

POTENTIAL INJURIES AND COMPLICATIONS

The potential risks of injury include but are not limited to:

  • Ureter
  • Iliohypogastric nerve
  • Ilioinguinal nerve
  • Sympathetic chain
  • Superior hypogastric plexus (SHP)
  • Vasculature including the mid-sacral vessels (MSAs)

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VIEW EVENTS

Brief Summary of Indications for Divergence-L™ Anterior/Oblique Lumbar Fusion System

Cage

  • Interbody fusion 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.
  • Use with autogenous bone graft and supplemental fixation cleared for use in the lumbar spine. Cages with a lordosis of 18º or greater must be used with at least anterior fixation.

Plate and Screws

  • Supplemental fixation: Anterior oblique L1-L5 above the vascular structures bifurcation; anterior L5-S1 below the bifurcation;
  • Temporary stabilization in patients with Degenerative Disc Disease (DDD); trauma; tumors; deformity; pseudarthrosis; and/or failed previous fusions.

When used together, DIVERGENCE-L™ components can be used only in patients with Cage indications.