Why I do it?
Why OLIF rather than other fusion techniques.
OLIF is a technique using the anterior to psoas approach to place an interbody cage and bone graft in the lumbar spine. The choice to place interbody cage and graft has to be made by the surgeon after considering multiple factors in the case concerned. An interbody cage is used to achieve fusion and restore interbody height and segmental alignment. Another theoretic advantage is that an anterior cage and graft in the lumbar spine will be loaded in compression during weight bearing and this can result in a more reliable fusion rate than posterolateral fusion used alone.
An interbody cage can be placed from a posterior approach (PLIF or TLIF). The posterior approach requires mobilisation and retraction of the dural sac and only allows for relatively small cages due to the access window being limited by the neural elements. Typically cage sizes of up to 14 or 15mm in height by 26mm long and 8mm wide can be placed with TLIF or PLIF. If the endplate is breached during disc removal or if the bone density is compromised then these small footprint cages can subside following surgery and lead to recurrent stenosis or deformity.
The amount of disc removed and surface area of endplate that is prepared for graft can also be limited and can be technically difficult in a degenerate disc stiffened by annular calcification or osteophytes. Overlying the disc there exists a venous plexus that often bleeds during the posterior approach and can make visualisation difficult as well as lead to significant blood loss if not controlled.
The transpsoas approach (DLIF and XLIF) can also be used to place an interbody cage that is much larger in width (typically 18-24mm) and length (typically 45-60mm) than the TLIF or PLIF cages. This allows for a larger contained graft volume and better coverage of the endplates. This approach is from the side and after separating the muscles of the abdominal wall, the retroperitoneal space is opened to gain access to the psoas muscle and then the disc. Multiple studies have demonstrated excellent interbody height restoration and fusion rates.