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.
INCISION OUTSIDE THE RECTUS
Similar to the McBurney-McArthur appendectomy incision (though here on the opposite side), 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.
NO PATIENT REPOSITIONING FROM L2-S1
The OLIF51 and OLIF25 procedures provide access from L2-S1 in a single position without the need to reposition the patient.
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:
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.
OLIF25 Surgical Position
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 to anatomical structure include but not limited to:
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VIEW EVENTSBrief 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.