OLIF is a variant of anterolateral approach to lumbar spine that aims to mitigate shortcomings of other anterior approaches. It utilizes surgical corridor termed oblique corridor that's located between great vessels and psoas muscle. In this review we aim to explore technical aspects of anterior to psoas approach and associated issues and dangers. Possible complications and prevention strategies will be discussed as well as different techniques and surgical tips. New developments in surgical technique and approach variations will be showcased
{"title":"Anterior-to-psoas OLIF: Surgical approach, issues & technical nuances","authors":"Stjepan Ivandić , Jure Pavešić , Stipe Ćorluka , Tomislav Čengić","doi":"10.1016/j.semss.2025.101159","DOIUrl":"10.1016/j.semss.2025.101159","url":null,"abstract":"<div><div>OLIF is a variant of anterolateral approach to lumbar spine that aims to mitigate shortcomings of other anterior approaches. It utilizes surgical corridor termed oblique corridor that's located between great vessels and psoas muscle. In this review we aim to explore technical aspects of anterior to psoas approach and associated issues and dangers. Possible complications and prevention strategies will be discussed as well as different techniques and surgical tips. New developments in surgical technique and approach variations will be showcased</div></div>","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"37 1","pages":"Article 101159"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143890844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.semss.2025.101172
{"title":"Contributors to authors","authors":"","doi":"10.1016/j.semss.2025.101172","DOIUrl":"10.1016/j.semss.2025.101172","url":null,"abstract":"","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"37 1","pages":"Article 101172"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143890849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.semss.2025.101163
Andrew James Berg , Prashanth J Rao , Jake Timothy
Traditional thoracotomy has long been established as an effective technique for treating anterior-based pathologies of the thoracic spine but is associated with significant morbidity, including high rates of respiratory complications and persistent thoracic wall pain. In response to these limitations, the minimally invasive lateral approach to the thoracic spine and thoracolumbar junction has emerged as a less morbid alternative, while offering comparable surgical access to the vertebral body, disc, and anterior spinal canal. This approach enables treatment of a wide range of pathologies — including trauma, infection, neoplasia, degeneration, and deformity — through procedures such as discectomy, spinal cord decompression, interbody fusion, corpectomy, and anterolateral instrumentation. Careful patient selection, thorough preoperative planning, and precise anatomical understanding are essential for its safe and effective application. This paper reviews the indications, contraindications, anatomical considerations, surgical technique, outcomes, and complications associated with the minimally invasive lateral approach, with particular emphasis on anatomical relationships of critical structures — including the diaphragm, aorta, and azygos vein — and technical aspects such as patient positioning, incision planning, diaphragm management, and retractor systems. Published clinical data demonstrating reductions in operative time, blood loss, hospital stay, and approach-related morbidity compared to traditional thoracotomy — while achieving equivalent or superior fusion rates and deformity correction — are outlined, along with evidence supporting the utility of this approach for specific anterior spinal pathologies. This paper provides a comprehensive resource for surgeons incorporating the minimally invasive lateral approach to the thoracic and thoracolumbar spine into their clinical practice.
{"title":"Minimally invasive lateral approach to the thoracic spine and thoracolumbar junction","authors":"Andrew James Berg , Prashanth J Rao , Jake Timothy","doi":"10.1016/j.semss.2025.101163","DOIUrl":"10.1016/j.semss.2025.101163","url":null,"abstract":"<div><div>Traditional thoracotomy has long been established as an effective technique for treating anterior-based pathologies of the thoracic spine but is associated with significant morbidity, including high rates of respiratory complications and persistent thoracic wall pain. In response to these limitations, the minimally invasive lateral approach to the thoracic spine and thoracolumbar junction has emerged as a less morbid alternative, while offering comparable surgical access to the vertebral body, disc, and anterior spinal canal. This approach enables treatment of a wide range of pathologies — including trauma, infection, neoplasia, degeneration, and deformity — through procedures such as discectomy, spinal cord decompression, interbody fusion, corpectomy, and anterolateral instrumentation. Careful patient selection, thorough preoperative planning, and precise anatomical understanding are essential for its safe and effective application. This paper reviews the indications, contraindications, anatomical considerations, surgical technique, outcomes, and complications associated with the minimally invasive lateral approach, with particular emphasis on anatomical relationships of critical structures — including the diaphragm, aorta, and azygos vein — and technical aspects such as patient positioning, incision planning, diaphragm management, and retractor systems. Published clinical data demonstrating reductions in operative time, blood loss, hospital stay, and approach-related morbidity compared to traditional thoracotomy — while achieving equivalent or superior fusion rates and deformity correction — are outlined, along with evidence supporting the utility of this approach for specific anterior spinal pathologies. This paper provides a comprehensive resource for surgeons incorporating the minimally invasive lateral approach to the thoracic and thoracolumbar spine into their clinical practice.</div></div>","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"37 1","pages":"Article 101163"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143890737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A variety of implants are used in Anterior-To-Psoas OLIF, with different cage materials and fixation strategies depending on patient characteristics, surgeon preferences, and surgical goals. Common materials include titanium and PEEK. Cages can be used in a stand-alone fashion or with supplemental fixation. However, there is no consensus on the optimal cage material or fixation technique. Options for fixation include embedded cage screws, posterior pedicle screws, and less common methods such as anterolateral screws and cortical bone trajectory screws. Recent advancements also include expandable cages and disc replacement.
{"title":"Oblique lumbar interbody fusion (OLIF) implants and lumbar disc replacement: Design, current status, and future directions","authors":"Stipe Ćorluka , Stjepan Ivandić , Mišo Krstičević , Tomislav Čengić","doi":"10.1016/j.semss.2025.101165","DOIUrl":"10.1016/j.semss.2025.101165","url":null,"abstract":"<div><div>A variety of implants are used in Anterior-To-Psoas OLIF, with different cage materials and fixation strategies depending on patient characteristics, surgeon preferences, and surgical goals. Common materials include titanium and PEEK. Cages can be used in a stand-alone fashion or with supplemental fixation. However, there is no consensus on the optimal cage material or fixation technique. Options for fixation include embedded cage screws, posterior pedicle screws, and less common methods such as anterolateral screws and cortical bone trajectory screws. Recent advancements also include expandable cages and disc replacement.</div></div>","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"37 1","pages":"Article 101165"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143890738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.semss.2025.101167
Andrew James Berg , Joseph Maalouly , Liam D. Rose , Prashanth J. Rao , Shay Menachem
Anterior-to-psoas (ATP) or Oblique Lumber Interbody Fusion (OLIF) procedures have gained popularity, resulting in an increasing number of studies reporting associated outcomes. Analysing these outcomes is crucial for understanding the procedure's benefits and limitations. This review identifies commonly reported radiological parameters, including indirect decompression, fusion rates, subsidence, spondylolisthesis reduction, and deformity correction. By evaluating existing literature, we provide a commentary on these parameters and their impact on clinical outcomes. This review serves as a valuable resource for surgeons, aiding in patient evaluation, surgical planning, informed consent, and technical execution of the procedure.
{"title":"Anterior to psoas fusion: Radiological parameters and associated clinical outcomes","authors":"Andrew James Berg , Joseph Maalouly , Liam D. Rose , Prashanth J. Rao , Shay Menachem","doi":"10.1016/j.semss.2025.101167","DOIUrl":"10.1016/j.semss.2025.101167","url":null,"abstract":"<div><div>Anterior-to-psoas (ATP) or Oblique Lumber Interbody Fusion (OLIF) procedures have gained popularity, resulting in an increasing number of studies reporting associated outcomes. Analysing these outcomes is crucial for understanding the procedure's benefits and limitations. This review identifies commonly reported radiological parameters, including indirect decompression, fusion rates, subsidence, spondylolisthesis reduction, and deformity correction. By evaluating existing literature, we provide a commentary on these parameters and their impact on clinical outcomes. This review serves as a valuable resource for surgeons, aiding in patient evaluation, surgical planning, informed consent, and technical execution of the procedure.</div></div>","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"37 1","pages":"Article 101167"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143890843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.semss.2025.101157
Johanna Oltmann, Kevin Seex
Anterolateral approaches to the spine have become essential for addressing a variety of spinal pathologies, offering an alternative to traditional posterior methods. These techniques, though effective, present anatomical challenges that require continuous innovation to improve safety and clinical outcomes. With an aging population demanding safer and less invasive procedures, spine surgeons increasingly rely on anterolateral approaches to treat conditions such as degenerative disc disease, spondylolisthesis, and deformities. Historical developments, including Ménard's lateral extracavitary approach, Müller's anterior lumbar access, and Hodgson and Stock's anterior spinal fusion, have shaped these techniques. Advancements like the retroperitoneal ALIF, mini-open variations, XLIF and ATP procedures have refined the approach, reducing morbidity and accelerating recovery. The shift to minimally invasive techniques has improved surgical outcomes, and as demand for these surgeries grows, further refinement of anterolateral techniques promises to enhance safety and efficacy in managing complex spinal disorders. This review summarizes the history and progress of anterolateral spine surgery.
{"title":"History of anterolateral spine surgery","authors":"Johanna Oltmann, Kevin Seex","doi":"10.1016/j.semss.2025.101157","DOIUrl":"10.1016/j.semss.2025.101157","url":null,"abstract":"<div><div>Anterolateral approaches to the spine have become essential for addressing a variety of spinal pathologies, offering an alternative to traditional posterior methods. These techniques, though effective, present anatomical challenges that require continuous innovation to improve safety and clinical outcomes. With an aging population demanding safer and less invasive procedures, spine surgeons increasingly rely on anterolateral approaches to treat conditions such as degenerative disc disease, spondylolisthesis, and deformities. Historical developments, including Ménard's lateral extracavitary approach, Müller's anterior lumbar access, and Hodgson and Stock's anterior spinal fusion, have shaped these techniques. Advancements like the retroperitoneal ALIF, mini-open variations, XLIF and ATP procedures have refined the approach, reducing morbidity and accelerating recovery. The shift to minimally invasive techniques has improved surgical outcomes, and as demand for these surgeries grows, further refinement of anterolateral techniques promises to enhance safety and efficacy in managing complex spinal disorders. This review summarizes the history and progress of anterolateral spine surgery.</div></div>","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"37 1","pages":"Article 101157"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143890851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.semss.2025.101161
Chang Hwa Ham, Woo-Keun Kwon, Joo Han Kim
The anterior-to-psoas (ATP) approach in lumbar fusion offers advantages but carries risks of vascular, neural, and ureteral injuries, as well as postoperative ileus (POI). Vascular injuries may cause significant hemorrhage, while neural complications can result in neurologic deficits and autonomic dysfunction. Ureteral injury, though rare, may lead to renal failure if undiagnosed. POI is associated with excessive careless manipulations causing local inflammations and pain. Preventive strategies, including meticulous surgical techniques, neuromonitoring, and careful tissue handling, are crucial to minimize complications and improve patient outcomes. This review highlights the importance of understanding and mitigating these risks to enhance the safety and efficacy of ATP procedures.
{"title":"Complications of anterior-to-psoas and their avoidance and treatment","authors":"Chang Hwa Ham, Woo-Keun Kwon, Joo Han Kim","doi":"10.1016/j.semss.2025.101161","DOIUrl":"10.1016/j.semss.2025.101161","url":null,"abstract":"<div><div>The anterior-to-psoas (ATP) approach in lumbar fusion offers advantages but carries risks of vascular, neural, and ureteral injuries, as well as postoperative ileus (POI). Vascular injuries may cause significant hemorrhage, while neural complications can result in neurologic deficits and autonomic dysfunction. Ureteral injury, though rare, may lead to renal failure if undiagnosed. POI is associated with excessive careless manipulations causing local inflammations and pain. Preventive strategies, including meticulous surgical techniques, neuromonitoring, and careful tissue handling, are crucial to minimize complications and improve patient outcomes. This review highlights the importance of understanding and mitigating these risks to enhance the safety and efficacy of ATP procedures.</div></div>","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"37 1","pages":"Article 101161"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143890847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.semss.2025.101158
David Strong , Joel Steiner , Robert Lee
Patient selection is vital to achieve success in the Anterior-to-Psoas (ATP) / Oblique Lateral Interbody Fusion (OLIF) approach. This technique, which offers unique advantages, can be technically demanding and requires careful preoperative evaluation to optimize outcomes and minimize complications. This article aims to guide surgeons in identifying suitable patients, perform a thorough patient workup and address the unique challenges associated with the ATP/OLIF procedure. In particular we discuss anatomical variations seen on imaging as well as important features in the patient history and examination. Through optimizing patients preoperatively and building a surgical plan for the individual's anatomy, the surgeon can minimize risks and improve patient's outcomes.
{"title":"Patient selection and workup","authors":"David Strong , Joel Steiner , Robert Lee","doi":"10.1016/j.semss.2025.101158","DOIUrl":"10.1016/j.semss.2025.101158","url":null,"abstract":"<div><div>Patient selection is vital to achieve success in the Anterior-to-Psoas (ATP) / Oblique Lateral Interbody Fusion (OLIF) approach. This technique, which offers unique advantages, can be technically demanding and requires careful preoperative evaluation to optimize outcomes and minimize complications. This article aims to guide surgeons in identifying suitable patients, perform a thorough patient workup and address the unique challenges associated with the ATP/OLIF procedure. In particular we discuss anatomical variations seen on imaging as well as important features in the patient history and examination. Through optimizing patients preoperatively and building a surgical plan for the individual's anatomy, the surgeon can minimize risks and improve patient's outcomes.</div></div>","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"37 1","pages":"Article 101158"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143890845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.semss.2025.101166
Liam D Rose , Gayani Petersingham , Andrew J Berg , Prashanth J Rao , John YS Choi
L5/S1 OLIF is a modern alternative to traditional ALIF. In this article we will review the differences between the two techniques with regards to their setup, approach, anatomical considerations, complication profile and additional advantages.
We believe that OLIF Is preferable to traditional ALIF When considering ergonomics, complications and ability to perform single position anterior and posterior fusion.
{"title":"L5/S1 oblique lumbar interbody fusion: Anatomical and technical considerations","authors":"Liam D Rose , Gayani Petersingham , Andrew J Berg , Prashanth J Rao , John YS Choi","doi":"10.1016/j.semss.2025.101166","DOIUrl":"10.1016/j.semss.2025.101166","url":null,"abstract":"<div><div>L5/S1 OLIF is a modern alternative to traditional ALIF. In this article we will review the differences between the two techniques with regards to their setup, approach, anatomical considerations, complication profile and additional advantages.</div><div>We believe that OLIF Is preferable to traditional ALIF When considering ergonomics, complications and ability to perform single position anterior and posterior fusion.</div></div>","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"37 1","pages":"Article 101166"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-26DOI: 10.1053/S1040-7383(24)00070-4
{"title":"Contributors to authors","authors":"","doi":"10.1053/S1040-7383(24)00070-4","DOIUrl":"10.1053/S1040-7383(24)00070-4","url":null,"abstract":"","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"36 4","pages":"Article 101147"},"PeriodicalIF":0.0,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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