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A novel surgical approach using the “lateral corridor” for minimally invasive oblique lumbar interbody fusion at L5-S1: a clinical series and technical note

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Abstract

Purpose

The minimally invasive oblique lumbar interbody fusion (MI-OLIF) L5-S1 was introduced to overcome the limitations of conventional fusion techniques, however, MI-OLIF is not possible using the standard method due to vascular structures in some cases. We aimed to introduce the “lateral corridor” and report the details of the surgical technique with a clinical case series.

Methods

We utilized the lateral access route of the left common iliac vein and named it the “lateral corridor”, to distinguish the technique from the standard technique (central corridor). The type and frequency of branch vessels that required additional manipulations were reviewed, and the frequency of intraoperative vascular injury was investigated.

Results

Among the 107 patients who underwent MI-OLIF L5-S1, 26 patients (24.3%) who received the “lateral corridor” technique were included. Branch vessel ligation was required in 42.3% of the patients. The types of branch vessels that required ligation were seven cases (26.9%) of the iliolumbar vein (ILV) and six cases (23.1%) of ascending lumbar vein (ALV). The ILV and ALV were ligated in two cases. None of the patients developed intraoperative vascular injuries.

Conclusion

We introduced the “lateral corridor” as an alternative approach for MI-OLIF L5-S1, implemented it in 24.3% of the patient cohort, and reported favorable outcomes devoid of vascular complications. The “lateral corridor” necessitated ligation of the ILV or ALV in 42.3% of cases. The “lateral corridor” approach appears to be a promising surgical technique, offering feasibility even in instances where the vascular anatomy precludes the employment of the conventional approach.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The English in this document has been checked by at least two professional editors, both native speakers of English. For a certificate, please see: http://www.textcheck.com/certificate/NsWT87

Funding

The study was partially supported by a grant from the Soonchunhyang University Research Fund (Soonchunhyang University, Asan, Souqth Korea).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Bucheon-si, Gyeonggi-do, 14584, Republic of Korea

    Hae-Dong Jang

  2. Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul, 04401, Republic of Korea

    Jae Chul Lee, Sung-Woo Choi, You-Sung Suh & Byung-Joon Shin

  3. Department of Orthopaedic Surgery, Soonchunhyang University Cheonan Hospital, 31 Soonchunhyang 6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do, 31151, Republic of Korea

    Chang-Hwa Hong

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Contributions

BJS contributed to conceptualization and writing—review and editing; HDJ done formal analysis and writing—original draft preparation; JCL, SWC, CHH, and YSS done investigation

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Correspondence to Byung-Joon Shin.

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No author has any other potential conflict of interest.

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The retrospective study protocol was approved by Institutional Review Board of Soonchunhyang University Bucheon Hospital, South Korea (IRB# SCHUH 2022–12-001).

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Supplementary file1 Video. 1 The surgical approach is demonstrated using a “lateral corridor” for the minimally invasive oblique lumbar interbody fusion at L5-S1. 1) We retracted the left common iliac vessels medially. 2) We applied specially designed retractors and fixed them with pins, and 3) we exposed the disc space and performed an annulotomy.

Supplementary file2 Video. 2 The surgical approach is demonstrated using a central corridor for the minimally invasive oblique lumbar interbody fusion at L5-S1. 1) We retracted the left common iliac vessels laterally. 2) We applied specially designed retractors. 3) We ligated the middle sacral veins by bipolar electrocautery, and 4) we exposed disc space and performed an annulotomy.

Supplementary file3 Video. 3 The process of ligating the iliolumbar vein during the surgical approach is demonstrated using a “lateral corridor” for the minimally invasive oblique lumbar interbody fusion at L5-S1. 1) We retracted the left common iliac vessels medially. 2) We exposed the iliolumbar vein (ILV), and 3) we dissected the margins of vascular structures and ligated them with multiple surgical clips.

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Jang, HD., Lee, J.C., Choi, SW. et al. A novel surgical approach using the “lateral corridor” for minimally invasive oblique lumbar interbody fusion at L5-S1: a clinical series and technical note. Eur Spine J (2024). https://doi.org/10.1007/s00586-024-08217-6

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