Anteroinferior Psoas Technique for Oblique Lateral Lumbar Interbody Fusion

Abstract

Oblique lateral lumbar interbody fusion (OLIF) has been extensively used, with satisfactory outcomes for the treatment of degenerative lumbar disease. This article aims to demonstrate a modified lateral approach, also known as the anteroinferior psoas (AIP) technique for OLIF, which is expected to enhance security by operating under direct vision. The core procedures of our technique are as follows. First, a minimal skin incision is recommended 2 cm backward compared with the normal incision of OLIF, facilitating the oblique placement of the working channel and the orthogonal maneuver for the cage placement. Second, two special custom-made retractors, as an alternative to the index finger, are used to pull the psoas muscle to the dorsal side and pull the abdominal organs together with extraperitoneal fate to the ventral side under direct visualization, making the exposure of the working channel convenient and safe and avoiding radiation exposure. Third, the anterior border of the psoas is bluntly dissected and retracted backwards, obviously enlarging the retroperitoneal anatomic corridor and then expanding clinical indications of OLIF. The benefits of this technique include that it has a short learning curve, satisfactory clinical outcomes, and low risk of perioperative complications.