Oblique lateral interbody fusion: Technique and pearls

Lumbar interbody fusion is a surgical procedure that fuses two or more vertebrae used to treat degenerative spinal conditions, instability, and deformities. There are several approaches commonly used, such as anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF), and lateral lumbar interbody fusion (LLIF), each with distinct risks and limitations. Anterior-to-the psoas oblique lateral interbody fusion (ATP/OLIF) is a surgical approach that was introduced to optimize lumbar interbody fusion while mitigating risks associated with the traditional approaches. ATP/OLIF utilizes an oblique surgical corridor between the psoas muscle and major vascular structures. ATP/OLIF offers a minimally invasive alternative for lumbar fusion, providing safe access to the L1-L5 levels, particularly L4-L5, with reduced risk of vascular injury (compared to ALIF) and lumbar plexus irritation (compared to PLIF). This chapter outlines the rationale, indications, surgical approach, and technical pearls essential for successful ATP/OLIF implementation. Compared to ALIF, TLIF, and LLIF, ATP/OLIF minimizes the need for vascular mobilization and neural retraction, improving surgical efficiency and patient outcomes.