Transfacet Oblique Lateral Lumbar Interbody Fusion: Technical Description and Early Results

Introduction The oblique lateral lumbar interbody fusion (OLLIF) is a relatively new method of lumbar interbody fusion (LIF) that utilizes a trans-Kambin approach to the disc space. The OLLIF can be performed from T12-S1 in the majority of cases but is occasionally obstructed at the L5-S1 level by osteophytes, an overgrown facet joint and/or prominent sacral ala. Transfacet OLLIF (TF-OLLIF) is a novel method for LIF in which the disc space is accessed by drilling through hypertrophic facets with an OLLIF approach. We provide a proof-of-concept report on the TF-OLLIF surgical technique and report the clinical and perioperative outcomes for the first 29 patients who underwent this procedure. Methods This is a retrospective single surgeon cohort study of 29 patients with lumbar spinal stenosis (LSS) who underwent TF-OLLIF procedures between 8/2018 and 1/2021. The primary outcome was a change in the Oswestry Disability Index (ODI) one year after surgery. Secondary outcomes were surgery time, blood loss, hospital stay, and complications. The TF-OLLIF was performed using the approach and instrumentation of OLLIF. When osseous hypertrophy is reached during the approach, an 8 mm drill is used to drill through the obstructing bone with continuous neuromonitoring. Discectomy and interbody placement are performed with subsequent posterior pedicle screw fixation. Results ODI improved from 49% pre-op to 31% at one-year follow-up. Estimated blood loss ranged from 97.6±93.3 ml for one level TF-OLLIF to 146.2±60.3 ml for a 3+ level TF-OLLIF. Operative time ranged from 57.4±19.5 minutes for a one-level TF-OLLIF to 102.9±27.8 minutes for a 3+ level TF-OLLIF. The average length of hospital stay (LOS) was 0.4±0.8 days for one-level TF-OLLIF and 1.6±1.9 days for 3+ level TF-OLLIF. Complications included five cases of nerve root irritation immediately postoperatively, with three of these patients still reporting mild L5 distribution numbness at the last follow-up, which was not clinically limiting. Conclusion The first 29 cases of TF-OLLIF demonstrated that it is a safe method of interbody fusion that yields good clinical results. This is an important development for practitioners of OLLIF as it enables interbody placement with OLLIF instruments and approach even for challenging L5-S1 levels without compromising surgical outcomes.