Low back pain is a common and expensive condition in the Western world with approximately 80% of individuals suffering from it at some point in their life. It is a major cause for loss of productivity as it is the leading cause of absence and limited activity at work for those under the age of 45 years old. It is also one of the most common causes for doctor visits and surgery in the United States. Current data shows that the rates of disability due to low back pain has skyrocketed, especially in those with disc issues.
Due to the constant increasing numbers of low back pain, in the 1950s, the posterior lumbar interbody fusion (PLIF) procedure was developed in the 1950s. The transformational lumbar interbody fusion (TLIF) was then developed and became a more popular alternative as there were less complications and faster recovery rate compared to the PLIF. However, it still required significant muscle detachment and denervation which led to the recent development of minimally invasive keyhole TLIF. This new minimally invasive keyhole technique benefits patients as there is significantly less blood loss, shorter recovery time, and less complications.
The oblique lateral lumbar interbody fusion (OLLIF) is also a new minimally invasive spinal surgery technique that allows the fusion of the lumbar spine using a small incision. Surgery time is also faster and has an easier approach compared to any other techniques. Utilizing the help of electrophysiological monitoring, the OLLIF procedure no longer requires the need of direct visual access during surgery.
Comparison based on study (numbers are based on 1 level fusions)
- Surgery time – OLLIF (69.24 minutes) has a significantly faster surgery time compared to minimally invasive keyhole TLIF (134.921.7 minutes).
- Blood loss – There is less blood loss in OLLIF patients (29.42 ml) compared to minimally invasive keyhole TLIF patients (355.0131.5 ml).
- Hospital stay – OLLIF patients (2.6days) have a shorter hospital stay compared to minimally invasive keyhole TLIF patients (4.22 days).
- Fluoroscopy time – Fluoroscopy is needed in minimally invasive keyhole techniques to help guide the surgeon during the surgery. It is longer in OLLIF patients (201.82 seconds) compared to minimally invasive keyhole TLIF (43.829.9 seconds).
The study has also stated that learning the OLLIF procedure is straightforward and found that the average surgery time drops rapidly as experience increases. According to research, OLLIF is the first spinal fusion that can be performed through one 10mm incision while for minimally invasive keyhole TLIF, an incision of 20mm or more is required.
The OLLIF procedure also relies solely on dilation and gently pushes the muscles away to allow access to the spine while for minimally invasive keyhole TLIF, muscles and soft tissues are striped and a facet is removed which increases the risk of complications for these patients. It is also hypothesized that OLLIF procedure has a better fusion rate compared to minimally invasive keyhole TLIF procedure.
In conclusion, based on current literature, OLLIF may be a more superior procedure compared to minimally invasive TLIF as it is a safer and less challenging surgery. However, the type of procedure performed may differ based on the different needs of each individual patient. Also, more studies are needed to learn more about the potential of OLLIF to improve the outcomes of patients who require lumbar fusions.