Citation: sardhara j, singh s, mehrotra a, bhaisora ks, das kk, srivastava ak, et al.Neuro-navigation assisted pre-psoas minimally invasive oblique lumbar interbody fusion (mi-olif): new roads and impediments.Neurol india 2019;67:803-12.Doi: 10.4103/0028-3886.263262.Abstract: introduction: minimally invasive spine-oblique lumbar interbody fusion (mis-olif) has emerged as a novel anterolateral, retroperitoneal, ¿pre-psoas¿ approach for lumbar interbody fusion for degenerative spinal instability, as well as for correction of deformity in patients without severe canal stenosis.In the last decade, the technique has gained popularity owing to several advantages like the minimal blood loss, minimal tissue dissection, preservation of posterior tension bands, better biomechanical strength, provision of mechanical stability to the lumbar spine, and a larger footprint of the implant, associated with it.It, thus, maximises load bearing on the cortical bone, and provides a better lordotic correction of the lumbar spine.The armamentarium is further boosted by the use of neuro-navigation and neuro-monitoring tools, thereby improving the surgical outcome.Material and methods: the clinical indications of mis-olif and various fixation methods [lateral lumbar fixation (llf) and percutaneous posterior pedicle fixation (ppf)] are discussed.The summary of the 15 patients on whom the technique was utilized, are discussed.The patients¿ demographics, clinical history and neurological examination data, pre- operative oswestry disability index (odi) and visual analogue scale (vas) score, intraoperative surgical details and postoperative follow up clinical as well as radiological data were assessed.Complications, readmissions, length of stay, estimated blood loss, surgical time and surgical outcome were also recorded.Results: 11 cases had grade 1 spondylolisthesis and 4 had grade 2 spondylolisthesis.One patient had both grade i and ii spondylolisthesis at different levels.13 patients had improvement in mechanical back pain and neurogenic claudication.Two patients had improvement in back pain but one-sided limb radiculopathy persisted, which was treated conservatively.The mean pre-operative odi score was 35 ± 6.1, which improved to 14.6 ± 4.1 at follow-up (range of follow-up: 1 to 10 months; mean 5.7 ± 3.3 months].The mean pre-operative vas score was 7 ± 0.7, which improved to 3.3 ± 0.4 at follow-up.Conclusions: the mis-olif technique at the l2¿l5 levels has shown encouraging early surgical outcomes with a good fusion rate and rapid recovery.While utilizing the unfamiliar oblique trajectory, the use of navigation can guide the surgeon in real time and also help in reducing the radiation exposure.Reported events: one (b)(6) male with mild back pain and neurogenic claudication treated with oblique lumbar interbody fusion (olif) and posterior pedicle fixation (ppf) had revision of one screw due to medial pedicle breach and post-operative transient gastroparesis which improved on medical management.One (b)(6) female with mild back pain and neurogenic claudication treated with olif and ppf had intra-operative transient hypotension (ith), end plate damage and cage displaced-transient sensory loss.It was noted that this was perhaps related to sympathetic chain injury.One (b)(6) male with mild back pain, bilateral l5 radiculopathy, lt canal stenosis (cs), and neurogenic claudication treated with olif and lateral lumbar fixation (llf) had the screw and plate pull out while the graft remained in situ.The screw and plate had to be removed.One (b)(6) male with mild back pain and neurogenic claudication treated with olif and lff had pain on the medial aspect of the thigh.The pain was intermittent and sharp shooting but decreased gradually on analgesic intake.One (b)(6) male with mild back pain treated with olif and oblique lateral lumbar stabilization through a reverse pedicle screw fixation (rpsf) had post-operative transient gastroparesis which improved on medical management.One (b)(6) female with mild back pain treated with olif and llf had post-operative transient gastroparesis which improved on medical management.Two patients had improvement in back pain but on one side, lumbar radiculopathy persisted which was treated conservatively.See attached article.
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