What is OLIF Surgery?
Oblique lumbar interbody fusion surgery is a minimally invasive technique for performing a spinal fusion. It can only be performed in the lumbar spine, at L2-3, L3-4, L4-5, and/or L5-S1.
Like all spinal fusion techniques, it is one of several techniques to help decompress the nerves and to stabilize the spine in the setting of instability or severe disc space collapse causing nerve compression and sciatica or radiculopathy.
OLIF spine surgery is usually performed in conjunction with a posterior spinal fusion to further stabilize the spine, which can also be performed minimally invasively.
The OLIF procedure is performed under general anesthesia.
The patient is positioned with their right side down and left side up for surgery.
After cleaning the skin and placing sterile drapes, a small incision is made over the appropriate spinal level.
If multiple levels are being operated on, sometimes one longer skin incision is made and sometimes multiple smaller incisions are made. The abdominal contents are moved to the side and the blood vessels are safely protected and the spinal discs are exposed. A vascular surgeon is often also involved in the operation to assist with the exposure. The psoas muscle which runs on the side of the spine is gently moved out of the way (for L2-3, L3-4, L4-5 levels) and a minimally invasive spinal retractor is placed. The disc is then removed and the ends of the spinal bones (vertebrae) are prepared for the spinal fusion.
The disc space is then measured and an appropriate sized cage is selected.
This is then filled with bone graft (usually taken from a bone bank) and/or a specialized protein used to stimulate bone formation, and then this is placed into the empty disc space.
Occasionally a plate and screws are also placed at this time to further enhance the stability of the construct. The retractors are then removed and the incision is closed.
If a posterior spinal fusion or a formal lumbar decompression is also being performed, the patient is then repositioned on their belly (prone) and that surgery is started immediately after the OLIF procedure is complete.
What to Expect After OLIF Surgery
If an OLIF procedure was performed to relieve leg pain from spinal stenosis, patients often find that the leg pain is significantly improved or even completely gone when they wake up from anesthesia.
After OLIF spine surgery it is normal to have some abdominal pain over the site of the incision. This will gradually resolve over several weeks.
OLIF surgery is often performed in conjunction with a spinal fusion with an incision in the back, so back pain is also common during recovery which will also gradually resolve.
Weakness and numbness in the legs, if present before surgery, can take longer to improve after surgery, usually weeks to months. If these symptoms were severe and present for a long time before surgery, the weakness and numbness may not fully recover.
Oblique Lumbar Interbody Fusion Recovery Time
After OLIF spine surgery, patients typically can go home after their pain is controlled on oral medications and they are able to tolerate eating without become nauseated. This means that patients can usually go home on the day after surgery or two days after surgery. If the OLIF procedure was only part of a larger spinal reconstruction procedure, the time needed in the hospital may be longer.
After going home, it is recommended to gradually increase your walking starting with two to three 5 minute walks per day and gradually increasing to two 15-20 minute walks per day.
Walking encourages blood flow and helps muscle and bone healing.
Lifting > 15lbs, twisting, and bending should be limited for the first 3 months after the surgery to limit the stress on the spinal instrumentation (cage, plate, screws, and rods) until your body begins to heal the spinal fusion.
At 3 months after surgery, patients can typically begin to increase their activities slowly as tolerated.
At this time core and spinal extensor strengthening is recommended using isometric exercises such as planks. Situps and crunches should be avoided. Formal physical therapy is typically not necessary. It usually takes at least 6 months to 1 year for the fusion to completely heal.
Post-operative visits are recommended at 2 weeks, 6 weeks, 3 months, 6 months, 1 year, and 2 years after an OLIF procedure.
OLIF Surgery Risks
While all spinal operations carry risks, the potential benefits of oblique lumbar interbody fusion surgery typically outweigh the risks.
The most common risks of OLIF surgery include:
Abdominal pain at the site of the incision and a small risk of developing an abdominal hernia
Risk of ileus - this means that the intestines go to sleep and patients have difficulty passing gas or having bowel movements after surgery. If this occurs, it usually lasts a day or two and then the intestinal function gradually returns back to normal. Minimizing narcotic pain medication and walking frequently decreases the risk of an ileus.
Risk of pseudarthrosis - this means that the bones do not successfully fuse together and heal into one solid bone. If this happens it can lead to eventual loosening or even breakage of the screws, plate, or rods and can cause recurrent pain symptoms. This risk is highest in patients who actively smoke cigarettes (nicotine decreases blood flow which is required for the spinal fusion to heal) and in those that are overweight (due to the increased stress on the spinal instrumentation)
Other rare risks of OLIF surgery include:
Risk of injury to the major blood vessels in the abdomen such as the aorta, or iliac veins or arteries. OLIF surgery is often performed along with a vascular surgeon who assists with the exposure of the spine, and who can then quickly perform a repair if there is an injury to a blood vessel
Risk of injury to the intestines or the ureter, which is the structure which carries urine from the kidneys to the bladder.
Risk of retrograde ejaculation, where semen flows backwards into the bladder rather than out through the urethra. If present this can cause infertility but does not interfere with the experience of an orgasm.
Continued back pain, leg pain, weakness or numbness. Even if the spinal fusion and decompression are successful, symptoms may persist due to degeneration at other levels, muscular components of back pain, or permanent injury to the nerves that was present before surgery.
Risk of infection
If you have more questions or would like to schedule an appointment with Dr. Nemani to see if you are a candidate for an oblique lumbar interbody fusion or OLIF surgery, please call 919-781-5600 or book an appointment online.