Oblique lumbar interbody fusion (OLIF)
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Oblique lumbar interbody fusion (OLIF) is one of several techniques used in lumbar interbody fusion. It provides minimally invasive access to the disc space, passing between the peritoneum and the psoas muscles.
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Indications for the procedure generally overlap with those of LLIF and include 4:
- low back pain
- degenerative lumbar scoliosis
- grade I and II lumbar spondylolisthesis 3
- lumbar instability
- mild-to-moderate spinal stenosis
The OLIF approach, as well as the lateral lumbar interbody fusion (LLIF) approach, does not require posterior surgery, laminectomy, or dissection (stripping) of the spinal and paraspinal musculature 3. Unlike the lateral approach, it also does not require dissection of the psoas muscle.
Although this technique can be used between L1-S1, for anatomical reasons, it is not necessarily preferred at L1-L2 (due to the thoracic cage, access to the disc space may not be optimal, and also due to the possible presence of floating ribs) as well as L5-S1 (due to the iliac wing and the need to mobilize the iliac vessels) 2.
With the patient positioned on their side (either right or left), this technique involves making a lateral and paramedian incision, then passing anteriorly to the psoas muscles. Unlike the LLIF approach, intraoperative centering and guidance are performed stereotactic rather than fluoroscopic navigation. Once the psoas muscle retraction is completed, discectomy is performed, and the interbody graft +/- device is implanted in the disc space.
Complications associated with this procedure are quite rare and mostly transient 5. The most common, likely related to retraction of the psoas muscle, include transient thigh numbness and hip flexion weakness (i.e. lumbar plexus injury). Other less frequent but more severe complications include vascular damage, urethral injury, and sympathetic chain dysfunction.
History and etymology
This procedure, with an anterior approach to the psoas (ATP), was first adopted by Meyer in 1977 1, but it is only with Silvestre (2012) 2 that it was referred to as OLIF.
- 1. Mayer HM. A new microsurgical technique for minimally invasive anterior lumbar interbody fusion. (1997) Spine. 22 (6): 691-9; discussion 700. doi:10.1097/00007632-199703150-00023 - Pubmed
- 2. Silvestre C, Mac-Thiong JM, Hilmi R, Roussouly P. Complications and Morbidities of Mini-open Anterior Retroperitoneal Lumbar Interbody Fusion: Oblique Lumbar Interbody Fusion in 179 Patients. (2012) Asian spine journal. 6 (2): 89-97. doi:10.4184/asj.2012.6.2.89 - Pubmed
- 3. Xu DS, Walker CT, Godzik J, Turner JD, Smith W, Uribe JS. Minimally invasive anterior, lateral, and oblique lumbar interbody fusion: a literature review. (2018) Annals of translational medicine. 6 (6): 104. doi:10.21037/atm.2018.03.24 - Pubmed
- 4. Mobbs RJ, Phan K, Malham G, Seex K, Rao PJ. Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF. (2015) Journal of spine surgery (Hong Kong). 1 (1): 2-18. doi:10.3978/j.issn.2414-469X.2015.10.05 - Pubmed
- 5. Li R, Li X, Zhou H, Jiang W. Development and Application of Oblique Lumbar Interbody Fusion. (2020) Orthopaedic surgery. 12 (2): 355-365. doi:10.1111/os.12625 - Pubmed