# Oblique/Lateral Lumbar Interbody Fusion



## KellyMac43 (Dec 11, 2014)

Any opinions on the below operative report would be greatly appreciated. One of my physicians are having a difference of opinion on this. 

Thank you

PROCEDURE:
OLIF (oblique lumbar interbody fusion) L2-L3, L3-L4, L4-L5 with
oblique/lateral exposure of L2-L3, L3-L4, L4-L5 disk space.  Intraoperative
assistance in closure.


DESCRIPTION OF PROCEDURE:
After obtaining written informed consent, the patient was brought to the
operating room and placed in the right lateral decubitus position and all bony
prominences were appropriately padded.  A CP monitoring was provided
throughout the procedure.  Foley catheter had been inserted.  SCD (sequential
compression device) were in place.  Preoperative marking with fluoroscopy was
obtained.  An incision approximately 5 centimeters anterior to the midbody of
L2-L5 was marked on the skin for planning.  She was then prepped and draped in
a sterile fashion.  Appropriate patient and procedure were confirmed with a
preoperative time out.  O-arm was used for use of the navigation system
throughout the procedure.

Vertical left lower quadrant incision was made 5 centimeters anterior to the
vertebral body extending from the L2-L3 disk space to L4-L5 disk space for
approximately 6 centimeters in length incision.  Dissection was carried down
through subcutaneous tissues and the external oblique fascia was incised.  The
L2-L3 disk was then accessed between the 11th and 12th rib in the
retroperitoneal space.  Muscle fibers were separated but not transected.  The
retroperitoneum was then entered both bluntly and with Endo Kittner and
peritoneal structures including the ureter were swept anteriorly.  The disk
was visualized and the lateral and anterior portion were exposed.  The L2-L3
disk space was confirmed with navigation and the stabilizing rod was placed in
the disk space without any difficulties.  Serial dilators were then placed
while performing stimulation and neural monitoring.  Once this was in good
position, Dr. XXX proceeded with placement of the retractor device,
diskectomy and placement of the artificial disk.  Please see his note for
details.  Once this was completed, the retractor system was removed and
hemostasis was assured.  The L3-L4 disk was then accessed through the same
incision by snipping the peritoneal structures just caudad to the previous
dissection.  All dissection was done anterior to the psoas.  There was an
excellent window present for this dissection.  The stabilizing rod was then
inserted into the L3-L4 disk along the anterior one-third with the assistance
of navigation system.  Serial dilators were placed while simulating and
performing monitoring.  Once the largest dilator was passed, Dr. Munson then
proceeded with placement of the retractor.  Again, L3-L4 diskectomy was
performed.  Please see his report for details.  Retractor system was then
removed with excellent hemostasis.  At the lower aspect of the initial
incision through a separate defect through the external oblique, internal
oblique, and under the 12th rib, the retroperitoneal structures were swept
forward.  An ileal lumbar branch was identified and was swept cephalad.  This
did not require ligation.  Further anterior structures off of the L4-L5 disk
and the anterolateral fifth vertebral body was performed with Endo Kittner.
The stabilizing rod was then tapped into the L4-L5 disk along the anterior
portion and serial dilators were placed while monitoring.  Once this was
completed, Dr. XXX then placed the retractor.  Further inspection was then
obtained and the psoas was assured to be swept posteriorly and the iliac
artery and vein which were visualized were swept anteriorly.  Dr. Munson then
proceeded with diskectomy and interbody fusion.  Please see his report for
details.  Once this was completed, a lateral plate was placed with
fluoroscopic guidance.  Retractor was then removed and hemostasis was assured.
The internal obliques were reapproximated with figure-of-eight Vicryl sutures.
External obliques were approximated with interrupted Vicryl sutures as well.
This was done both above and below the 12th rib.  The fascia overlying the
external oblique was then closed with interrupted 0 Vicryl sutures as well.
Dermis was closed with a running 3-0 Vicryl stitch.  Skin was closed with a
running subcuticular Monocryl stitch.  Dermabond was applied.  A total of 10
mL of Marcaine had been injected for local.  Sponge and needle counts were
correct at the end of the case.  Completion x-ray showed no evidence of
retained instruments.


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