With aging, there may be different problems that disrupt the health of the spine. While non-surgical treatment methods are also used in the treatment of problems caused by calcification in the spine, different techniques can be used in cases where surgery is required. OLIF surgery; It stands out as a preferred surgical technique in cases of nerve compression due to calcification in the spine, mild-to-moderate narrow canal disorders, mild lumbar vertebrae displacements, flat back syndrome and scoliosis in middle-aged patients after previous and unsuccessful lower back operations. Spine Surgery Specialist Assoc. Dr. İsmail Oltulu from Memorial Şişli Hospital Orthopedics and Traumatology Department gave information about OLIF surgery.
What is OLIF surgery?
Oblique Lumbar Interbody Fusion, in short, OLIF surgery, is a surgical technique that is mostly performed on adult patients in cases such as narrow canal of the spine due to calcification of the spine, nerve compression due to calcification in the spine, lumbar vertebrae displacement in the spine.
In patients, surgical procedures, which are usually called fusion surgery, in which the vertebrae are fixed by connecting them with screws or implants, can be performed on patients. The vast majority of these operations are performed from the backside of the patient, that is, from the lumbar region. These operations are mainly divided into two as stabilization by screwing only (posterior stabilization (PLF)) and placing a cage from the back to the anterior of the vertebrae with screwing (TLIF/PLIF). In these stabilization procedures, if spinal cord compression is present in the patients, relieving the pressure is also performed under the microscope. OLIF surgery is one of the fusion surgery techniques in which small incisions and large cages are placed between the problematic spines.
In OLIF surgery, screwing is performed as in other surgeries, but wide cages, defined as wedges, are placed in the anterior part of the problematic vertebrae from the patient's abdominal cavity. Placing wide cages from the front side of the body with OLIF surgery provides significant advantages over classical surgical methods (TLIF/PLIF/PLF). Cages can be placed between the vertebrae in TLIF/PLIF surgeries. However, since the operation is performed from the backside of the body, these cages are not as wide as in OLIF surgery.
In what diseases is OLIF surgery performed?
OLIF surgery is mostly preferred for degenerative spine problems. Usually developing due to calcification in the spine;
· Mild to moderate narrow canal in the spine
· Mild spinal displacement(lumbar vertebrae displacement)
· Spinal calcification and related nerve root compressions
· Scoliosis of the lower back in elderly adult patients
· Patients who have lost the lumbar dip, which is called flat back syndrome
· This operation can be performed in previously unsuccessful lower back operations(in revision spinal surgery).
OLIF surgery is not preferred for spinal fractures or spinal traumas.
How is OLIF surgery performed?
· OLIF surgery is performed under general anesthesia in the operating room environment.
· The problematic vertebrae are identified and marked from the anterior abdominal wall of the patient.
· With the help of an imaging device called fluoroscopy, an incision of about 5 cm is made to reach the problematic vertebrae. However, if there is more than one problematic vertebra, the length of the incision may increase or surgery can be performed with more than one incision.
· OLIF surgery is performed by entering from the front side of the body. Retractors are placed to prevent damage to the intestines and nerves while reaching the vertebrae.
· The structures called discs between the vertebrae act as a cushion between the bony bodies like a gasket. In these operations, the discs located on the front of the vertebrae are emptied, meaning, cleaned. The bone structure is completely revealed with the disc cleaning process performed with fluoroscopy.
· After the bony surfaces of the vertebrae are exposed, a large cage is placed between the two vertebrae. They are circular or rectangular materials called cages, generally made of titanium or polyetheretherketone (PEEK cage). Bone material is also placed in cages placed to fuse the two vertebral bodies together.
· After this procedure, the patient is turned to the prone position and the screwing is done. If there is no need for nerve release from the back of the patient, screwing can be performed with closed methods.
Frequently asked questions about OLIF surgery
How many hours does OLIF surgery take?
OLIF surgery time varies according to the number of problematic vertebrae. But in general, OLIF surgery takes about 1.5 – 2 hours.
What are the advantages of OLIF surgery?
· The classical method in calcification, lumbar vertebrae displacement, spinal displacement or narrow canal surgery is the screwing operation performed from the posterior side of the body, that is, the back. In these surgeries, which are called TLIF / PLIF method, cages are placed between the vertebrae. In OLIF surgery, cage placement between the vertebrae is performed from the anterior side of the body. Performing OLIF surgery with a minimally invasive method, meaning, by entering through the anterior abdominal wall with small incisions, allows the placement of larger sized cages between the vertebrae. The aim here is fusion, that is, the fusion and fixation of the two vertebrae to each other. Wide cages placed between the vertebrae increase the rate of fusion.
· The high rate of fusion of the vertebrae in OLIF surgery minimizes the risk of experiencing problems such as rod breakage due to not fusing and loosening of screws, which are the most common problems especially in the advanced age group.
· Again, due to the high rate of fusion, the likelihood of going under revision surgery also decreases.
· The possibility of contact with the spinal cord is high in TLIF/PLIF surgery, which is called classical surgery in calcification,lumbar vertebrae displacement, spinal displacement or narrow canal surgeries. Complications due to this contact are decreased in OLIF surgery.
· Less bleeding occurs in OLIF surgeries.
· Hospital stays are much shorter.
· Recovery after surgery occurs much faster.
· The pain and complaints experienced go away quicker.
· In patients who do not need canal expansion, screwing can be done with closed methods.
· The spine has two main tasks, supporting the body and protecting the spinal cord passing through it. Between each vertebra there are holes called foramen where the nerve roots come out. One of the biggest causes of pain experienced in patients is the deterioration of the structure of the discs between the vertebrae, the narrowing of the distance between the vertebrae and the holes where the nerve roots come out, and the pressure on the nerve root. Since the cages placed in the OLIF surgery also increase the distance between the vertebrae, the complaints that occur as a result of compression on the nerve are reduced.
· In OLIF surgeries, both wide cage placement and screwing accelerate fusion, i.e. fusion time. In this way, the return of patients to work and social life is much faster and the success rate increases in the long term.
· In these patients, if there is an accompanying scoliosis or flattening in the lower back, these problems can be corrected without any other procedure.
What are the risks of OLIF surgery?
· There are risks associated with the intervention. Since OLIF surgery is performed by entering through the anterior abdominal wall, the spine is reached by entering through the intestine and large vessels. Although it is very low, there is a risk of damage to the intestines and large vessels during surgery.
· Although there is not contact with nerves during the OLIF operation, pain may occur in the thigh region due to the long-term pressure of the retractors placed.
· Even if there is no damage to the intestine after surgery, there may be a slowing in bowel movements, such as intestinal laziness.
Can OLIF surgery be performed outside the lumbar region?
OLIF surgeries are defined as a operation that is only for the lumbar region.
What are the symptoms of a narrowing canal ?
The narrowing canal problem most often occurs in the cervical and lumbar regions of the spine. The narrowing of the canal occurs less often in the back region of the spine. Complaints vary depending on the region where the narrowing canal occurs. Narrowing canal disease is actually known as an old age disease. It can usually start after the age of 50 and progress very slowly. Symptoms may increase gradually. The narrowing of the canal occurs after the spine tears, wears out and calcifies over time. Although rare, canal narrowing can occur congenitally. In these patients, symptoms may begin earlier
If the canal narrowing is experienced in the neck area, there may be signs of burning, tingling, and weakness, especially in the arms. With the emergence of canal narrowing in the lumbar region, tingling, numbness and weakness can be seen in the legs, thighs and hips.
The symptoms experienced in the very advanced stages of canal narrowing are as follows;
· Bowel or bladder dysfunction (Incontinence)
· Changes in gait, such as unsteady gait or walking with small steps
· Impairment of sexual functions
· Weakness in the legs
· The need to rest after walking a certain distance These pains subside with rest.
· Walking leaning forward or needing to sit when leg pain occurs can be symptoms of stenosis(narrowing).
How is the narrow canal diagnosed?
Magnetic Resonance (MRI) and Computed Tomography (CT) imaging methods are most often used for diagnosis when a patient with symptoms of a narrow canal comes to the hospital. With imaging methods, the narrow canal can be seen in great detail. The spinal canal has a certain diameter. Narrow canal diagnosis is made by determining that this diameter is reduced in radiological imaging.
Is there a treatment for narrow canal without surgery?
· The type of treatment should be determined individually for each patient. Not every narrow canal patient needs to be treated with surgical methods.
· Exercise therapy is recommended if the patient has mild and moderate symptoms. If the symptoms do not cause serious neurological problems, meaning that if there are no signs such as loss of muscle strength, urinary and fecal incontinence, non-surgical methods should be tried first.
· In patients with mild complaints of narrow canals, changes in daily activities should be made first. In addition to lifestyle changes, exercises that will increase the flexibility of the spine are recommended. Hot or cold compressions to the aching lumbar region can be beneficial.
· Physical therapy methods can be used in patients whose symptoms are more severe. These methods do not reduce the pressure on the nerve, but they can alleviate the patient's complaints. The aim is to regress the patient's complaints without surgery.
· Another non-surgical method is injection applications. Injection treatments in a narrow canal are preferred in patients whose symptoms are not very severe.
Surgical treatments should be considered in patients whose complaints do not decrease with non-surgical methods.
In narrow canal surgery, screwing methods or canal expansion surgeries can be performed. Open surgical methods are preferred in very serious narrow canal patients. There are many surgical methods related to narrow canal disease. As the symptoms can vary from person to person, surgery and treatment methods also vary according to the patient. Personalized treatment methods should be applied. Cemented screws can be used in patients with poor bone quality and who are unable to retain screws. Screwless surgeries are preferred in patients with other advanced illnesses who cannot handle major surgeries and whose bone quality is extremely poor.
What causes the narrowing of the spinal canal?
· Spinal canal narrowing is a disorder that usually occurs in old age.
· It occurs as a result of wear and tear of the discs, joints (facet joints) and ligaments of the spine.
· Over the years, wear and tear of the ligaments or ligaments protecting the spinal cord, can lead to the formation of bone tissues that should not be thickened and calcification of soft tissues. These formations can narrow the canal over time.
· Spinal canal narrowing occurs gradually over time. However, sometimes congenital narrow canal can be experienced. Symptoms in these patients appear at an earlier age.
· Spinal canal narrowing can also be caused by a tumor.
· A narrowing of the canal may also occur due to a lumbar disc herniation.
· Narrow canal discomfort may occur after spinal fractures.
What happens if the narrowing canal is not treated?
If there are severe symptoms such as loss of muscle strength, untreated canal narrowing may lead to an increase in neurological problems in these patients. Gradually, problems such as walking disorders and incontinence occur in the patient and can be permanent. If surgery or non-surgical treatments are delayed, there is a possibility that the complaints will be permanent.
How long does narrow canal surgery take?
The duration of narrow canal surgery may vary in proportion to the levels of narrowing. Since duct narrowing is more of an advanced age disease, narrowing is usually not experienced at a single level in these patients. If the canal narrowing is at more than one level, it may prolong the operation time. Canal narrowing surgery at a single level lasts on average between 1.5-2 hours. If the canal narrowing is between more than one vertebra, the operation time may be prolonged.
How long is the recovery period after narrow canal surgery?
The recovery time of narrow canal surgery may vary depending on the surgical procedure performed. After fusion surgeries, the patient can return to normal activities in an average of 3 months. Non-heavy sports activities can be performed, but it is best to wait 1 year for heavy sports. People working in light jobs can return to work after about 3 weeks. In heavy work, this period can be up to 6 months. Recovery is directly proportional to the level of surgery.
What are the symptoms of a spinal displacement?
A spinal displacement, popularly known as a lumbar vertebrae displacement, is a displacement of one vertebra forward or backward in front of another. The diplacements usually occur towards the front. There are degrees of spinal displacement. OLIF surgery can be preferred in 1st and 2nd degree spine displacements. However, OLIF surgery is not suitable for severe spinal displacement.
Symptoms of a spinal displacement can be listed as follows;
- Lower back pain
· Depending on the severity of the displacement, pain and numbness can spread to the legs, thighs and hips.
A vertebral displacement does not heal by itself. If there is a complaint, it is necessary to treat the patient's complaint. If there is no serious loss of muscle strength, non-surgical treatment methods should be tried.
Prepared by the Medical Editorial Board. Our health library contents have been prepared for informational purposes only and with the scientific content on the registration date. For all your questions, concerns, diagnosis or treatment about your health, please consult your doctor or health institution.