OLIF (Oblique Lateral Interbody Fusion) - Procedure details, recovery expectations and more!

[@ironmanstan]

I am having this surgery in a month and you really showed the detail of the entire procedure. Thanks for the information. You are a great teacher!

[@medicalstudent8667]

Although this is meant for patients, as a med student, this is amazingly helpful to understand the basics, and be able to reassure patients about what they can expect during recovery! Thank you :) I'm blown away by the editing of all the surgical steps on the Netter's diagram.

[@ArmaghaniSpine]

Thank you so much and good luck on your journey!

[@saltlakrids]

I now watched the TLIF and OLIF videos in full laying here recivering 1-day post-up from L4/L5 discectomy and L5/S1 stenosis from a precious surgery 10 years ago. I was not aware that the leg increases the pain signals while the nerve is pinched, but it kind of makes sense. Very high level of information. Great illustrations. Good job doctor👍

[@ArmaghaniSpine]

Thank you so much and feel better!

[@sabrinawood3885]

This video is fabulous! Now I understand!! Thank you!

[@jonsuh3045]

Amazing, amazing, explanation.... I m an engineer but feel like I can do a surgery. Gained so much knowledge. Thank you so much.

[@ArmaghaniSpine]

My parents are engineers and had them critique some of my earlier videos to explain it more in their terms! Glad you found it helpful!

[@mdodge1960]

Hello Dr. Armaghani, how do you decide who is a candidate for OLIF and how many levels can be fused with an OLIF? Your videos are very informative. Thanks Mark

[@mayabobovik1906]

Thank you, doctor Amazing explanation I have had six levels of L1-S1 disk replacement and a laminectomy for stenosis You only explain one level I'm on the road to recovery , three no post op Your site is very helpful

[@ArmaghaniSpine]

You are welcome!

[@prof.tirdaddaei920]

Merci and happy Nowruz! Very informative, I am having this surgery soon.

[@ArmaghaniSpine]

best of luck!

[@lucaluxPolaris]

Hello Dr. Armaghani ，I am very glad to see this video, your explanation enables me to have a detailed understanding of this operation. As a young med student in China，I also specialize in spinal, I have to admit that the medical education in foreign countries is far ahead, and I can't wait to watch your other videos. However, med students in China often takes on heavy clinical tasks. Maybe l'll cleck it later！

[@ArmaghaniSpine]

looking forward!

[@thugnlive]

Dear Dr, That was an extremely informative video presented in an easy to understand manner. I am about to undergo this procedure but I was informed about having a synthetic disc placed rather than a cage. What worries me most....is the recovery period. I am an active sporty person...been working out for over 13 years...i ride motorcycles too and have a lot of passions that involve physical activity. The idea of not being able to do these things simply scares me. Kind regards from Poland

[@ArmaghaniSpine]

The key is to follow your post-op instructions from your surgeon and eventually following surgeries like this people can get back to what they were doing before. It is important though to let your body heal. good luck!

[@thugnlive]

@@ArmaghaniSpine Thank You kindly for responding. Sure will do!

[@anonymousbosch949]

Can you give us a 2 year update on your post op recovery? I just had this procedure a week ago.

[@R3DLiN3]

Can you post a video on Lateral Spine Surgery please? I love your explanations on all of the techniques. Very informative and detailed.

[@ArmaghaniSpine]

I am likely doing a prone lateral video later this year. The OLIF video is almost exactly what a lateral surgery is except instead of moving the psoas over you dissect through it to place the cage. Same risks and post-op recovery course.

[@drdeepparmar-bestneurosurg2196]

When to use OLIF and when to use TLIF .. please elaborate

[@notezbeinggreencm]

Excellent , thanks

[@khaledortho6360]

Scoliosis and kyphosis surgery step by step please You have attractive character in how to explain easily ,

[@Lynn-yo2tz]

This was so helpful. This was what my spine surgeon recommended yesterday. I have had three back surgeries in five years. Currently I have a ruptured disc L2-3 and quite a lot of pain in my back and front of thighs. I had a fusion L4-5-S1 five years ago, then ruptured L3-L4 and had another fusion three years ago. Then I fell and fractured through where the bone was harvested for the first fusion and extending into the S-I joint and had that fused via a lateral approach. (The fracture didn’t heal without surgery, he said nonunion.) And now this. Is THIS SURGERY more or less painful post operatively? Is this procedure more or less predicable or successful that the posterior approach? I feel like the unluckiest person alive. Also, my spine surgeon said a vascular surgeon would do the initial part, then he does the disc part, and then the vascular surgeon closes it. Is that common?

[@ArmaghaniSpine]

Some people use a vascular surgeon and others don't. The closer you get to the sacrum, the more variable vascular anatomy is so i do like to use a vascular surgeon for those situations like L5/S1 or some L4/5 levels. I like the surgery because I feel that by sparing the posterior muscles from an incision recovery is faster and easier on them. It's not for every situation but for most I can do it.

[@Lynn-yo2tz]

Thank you so much for this informative presentation. I’m having the surgery tomorrow. Your presentation helped me understand. I would choose you as a surgeon in a heartbeat.

[@carolwong5949]

You are giving me hope. I am 75, and have DDD L4-5 is the worse of all discs going bad. The MRI report says that there is severe disc height loss and disc desicculin (all discsL1-5 have the latter. The report includes a 4mm osteophyte on the left, in short. I have constant pain every day, cannot take Nsaids due to iron deficiency anemia. I get told that I am not ready for surgery, I had the MRI in February 2020 and the pain is worse. I cannot do stairs. often am bent over when I walk with a walker. A lot of pain when I get up from a sitting position and doing PT for 4th time. I am told there is nothing that can be done. Now I think that it would be worth a try with a good back surgeon.

[@ArmaghaniSpine]

There are many options for patients prior to surgery that you should discuss with a surgeon just to understand your options. Some of these options include epidural injections but it is always a good idea to hear all your options so you are most educated in making the best decision for you. Good luck!

[@katalinagirl]

@@ArmaghaniSpine but sometimes epidural injections can be even further disabling and cause things to be worse. As a surgeon how do you know when NOT to recommend an epidural injection based on a patient's pathology?

[@Exec-eo1kz]

This was so helpful!!

[@BrettLee0]

I just had this done. Reach out to me from patient perspective for any questions

[@Christinejs]

Hi. How are you doing now and why did you do it this way? Do you recommend

[@Isaac5123]

Where is this specialist? He is amazing

[@ArmaghaniSpine]

I am based out of Orlando, FL with Orlando Health Jewett Orthopedic Institute. www.orlandohealth.com/physician-finder/sheyan-armaghani-md#/overview

[@hollyseesholtz8315]

Well done Dr. Armaghani! Very informative! Do you ever increase the spinal cord space if it is impinged?

[@ArmaghaniSpine]

great question. by placing the cage between the bones as shown here, we are able to increase the space between the vertebrae and that also increases space for the spine.

[@katalinagirl]

If you were the surgeon and performed an OLIF & PLIF at L1/L2 and your patient ended up having complications with left sided oblique area abdominal paresis (pseudohernia) stretching nearly to the navel from the side incision area and also has this paresis down in the left lower ab down in to the inner to top mid thigh and in to the groin area, what would you suspect as being the problem here? How would you go about dxing this post op nerve complication that remains unresolved in your patient after over 2 months of no changes? Keep in mind the PLIF there was no bone removed nor posterior decompression performed here. This hardware was only added as the patient had some kyphosis and retrolithesis at this area pre-op so as to stabilize the area in support of the OLIF and to improve the fusion process. In addition, there was no internal plate or screw fixation used & only a cage spacer that was put in during the OLIF procedure.

[@ArmaghaniSpine]

pseudohernia is a relatively rare complication that can occur with laterally based procedures. Recovery is slow but most, if not all, recover by 6 months. So it does take a while but does improve in patients. The nerves that are affected by this do not come from the area where the surgery was though. It comes from the more superficial nerves closer to the incision that are stretched and those take time to heal.

[@indrasaikumar5789]

I have underwent 2 times of microdiscectomy and landed into spondylodiscits.. doctors are suggesting TLIf and OLIF ..which is better to undertake ..what would be the surgical outcome .. microdiscectomy done at level of L4-L5

[@tompang8316]

Is LLiF the same as OLLIF ? Do we have to have the screws on both sides ?

[@katalinagirl]

How often are you performing an OLIF and PLIF combination? What are your post-op instructions after performing such a surgery? Do you keep your patients in a brace immediately post op and if so for how long? What types of restrictions are in place and for how long until a patient is fully released to most physical sport activity such as SUP, surfing, mountain biking and such? Trying to get a picture of how your post op and PT referral and instructions and restrictions work and in comparison to what I've experienced here locally in my area for a surgery like this at L1/L2 OLIF w/PLIF. Thank you

[@ArmaghaniSpine]

I almost never perform a stand alone OLIF. I'll always back it up with screws and rods. For those patients, I generally say to them to just walk as much as they feel comfortable doing and to avoid bending, twisting, or lifting more than 20lbs for the first 6 weeks after surgery. After 6 weeks some patients need therapy but most don't. They can return to full activity at 6 months.

[@NiccBlacc-NCBC]

Im guessing this isnt possible for L4 TO S1 fusion. Only ALIF or PLIF

[@maysmith7994]

Very informative thank you dr Armaghani. What's your thoughts on ADR?

[@ArmaghaniSpine]

I think it is a great surgery for the right patient in the right area (L5/S1) but I suspect in the future everyone will be getting disk replacements

[@maysmith7994]

@@ArmaghaniSpine thank you doctor. How about L4L5 ADR? Please do a video on ADR!

[@khawlaelayyan4942]

thanks dr for your very informative video .I had olif surgery with fusion for l5s1 spondylolisthesis 10 weeks ago and still suffering from leg muscle spasm .is that normal and is there anything that i can do to relieve it .thanks again.

[@ArmaghaniSpine]

it's important to keep your regularly scheduled appointments with your surgeon who can check your progress and see if its appropriate compared to the amount of work done

[@danielcunha1081]

Loved the video, very well explained. How do you film yourself and the slides at the same time?

[@ArmaghaniSpine]

Carefully! I use a green screen and a video webcam. Then I'm able to overlay myself within a power point presentation while I lecture. I use a program called OBS Studio that a lot of Twitch video game streamers use and that is where I got the idea. I figured seeing the lecturer during the video would make it a little more interactive. Thank you for the words!

[@danielcunha1081]

@@ArmaghaniSpine your videos are so cool that I want to do something similar, I hope you don´t mind, especially since we are very far from each other. I live in Brazil and would do them in Portuguese for my patients. Did you get your images from Netter anatomy book ?

[@pawanmahant6672]

U duffer ..read my comment

[@hollyseesholtz8315]

Is there a way to find surgeons in my area, San Antonio, TX who do this procedure?

[@ArmaghaniSpine]

I don't know any docs in the San Antonio area but there are many in Dallas who perform this procedure.

[@Isaac5123]

Am on waiting list for si joint stabilisation but feeling petrified just in case the problem is L4 L5 and not my si joints as I have pain down inside both legs to the feet. L3 nerve block did not take away the pain.

[@Lynn-yo2tz]

Wow, I can feel your anxiety about that because that’s exactly where I’m at. I think I have both problems. I already had the left side S-I fusion but now I have all the signs and symptoms of right side S-I. But the MRI shows herniated and collapsed space L2-3 and my surgeon has recommended this procedure. I sure hope this will provide enough pain relief.

[@johnehteshami725]

Dr. Armaghani any reason to go on the right side vs the left side?

[@ArmaghaniSpine]

John, excellent question. Most go on the left side especially higher up at the L1/2 and L2/3 levels because you do not have as much interferences from the liver. You can go from the right side at 4/5 and 3/4 as well and we have done that in the past for patients who have had retroperitoneal surgeries or prior lateral surgery at those levels. In addition some patients with scoliosis you can go in on the right side and have an easier time placing the cage in. 95%+ I do are from the left side though. Thank you for the question and feedback. Sheyan

[@g.pearson-dixon3328]

Excellent information!

[@ArmaghaniSpine]

Thank you, G!

[@lisatester1110]

Great video!!!!

[@ArmaghaniSpine]

Thank you!

[@marshallcoolins8112]

Have you done this procedure on a patient with existing “spinal hardware “ ( zelke rod) Female scoliosis surgery when she was 13. She is now 46 thanks.

[@ArmaghaniSpine]

Not personally, but in these cases surgeons usually will try to avoid removing the old hardware and try to hook into it with special instruments and tools.

[@michaelknight2721]

Dr Armagnhi, I have am in so much pain in the lumbar L4,L5 area with terrible pain in both my buttocks and down my calfs and feet and ankles and feet. I have been told I have a fracture of the L4 and a burst L5 fracture with bone fragments in the spinal canal with tight stenosis. Iam also bent like a little old woman.Could you tell me whether I would be able to be straightened back up? Also I have been told I have narrowing of the foremen especially on the left. Could you tell me what procedure I would need. Thanking you. If you would please reply you would take a lot off my mind.Could I get my old life back?

[@paulojimenez9904]

Great job 👏

[@ArmaghaniSpine]

Thank you!

[@phyllisstevens6637]

Also my sons back has curved at the bottom of spine and rods. Rods have been in since 2000. He is 35. Is in so much pain

[@PortlandSara]

Do you know why that happened?

[@phyllisstevens6637]

Can this procedure be done if you have rods in your back?

[@ArmaghaniSpine]

yes it can, just some slight modifications have to be made in general.

[@phyllisstevens6637]

@@ArmaghaniSpine With the new curvature. Would you fuse the bottom? Would it take away his mobility? He can still bend at the waist now

[@scottstaniewicz688]

Dr Armaghani, if the OLIF good for L5-S1 fusion?

[@ArmaghaniSpine]

I love that option for L5/S1. I do it about 90% of the time for L5/S1

[@KBradAdams]

How is this different from a ALIF fusion?

[@ArmaghaniSpine]

great question. the cages are slightly different and the positioning is different. you also enter the disk space from the lateral position where with an ALIF you go straight through the front of it. This matters because you have blood vessels in front of the spine in some areas and on the side in other areas.

[@lklovsky]

do you use access surgeon for alif and olif?

[@ArmaghaniSpine]

It depends on how the patient's anatomy (mainly blood vessels) are. There are OLIF cases where I will use a vascular surgeon and others that I will do myself. Every ALIF case, I do use a vascular surgeon because of the location of the disk that I am doing the ALIF on (95% at L5/S1 which has specific blood vessel risks that I want a vascular surgeon there to address if something happens).

[@MrGouseustad]

Can you access l5 s1 disc with olif ?

[@ArmaghaniSpine]

Yes, absolutely! In greater than 90% of patients, the anatomy is favorable to perform an olif at L5/S1. Great question.

[@tonysorice5142]

doctor i have a L4 L5 S1 i just got my new i had 3 MRI but this one says L5 S1 broad posterior disc hernation which is slightly more prominent than on the prior study deforms the ventral epidural space and there is left greater than the right foraminal extension with abutment of exiting left L5 root and narrowing of the foramina diminished disc space height ventral extension of the disc remains and discogenic chages and scmorl;s node in the end platates.mild facet hypertrophic changes remain L4L5 S1 ,,,,,doc my friend told me narrowing part of stenosis ,doctor can you help me out with this ,,thank i been watching ur video;s there very good ,,thank you,,ps my doc can be fixed with endoscopic laser surgery,doc what do you think,

[@ArmaghaniSpine]

Hi Tony. It's difficult to say without looking at your imaging and examining you, but generally, I can say that patients who have more buttock and leg pain compared to lower back pain have better outcomes than those with mostly or exclusively back pain (meaning belt line and above). Speak with your surgeon and see if that fits your case and you can choose together whether the benefits outweigh the risks. Good luck!

[@bryanfox4416]

how do you know where to go in height wise (up and down from waist to chest)?

[@ArmaghaniSpine]

That's a great question, Bryan. We have an idea in our minds about how much taller we want to make the disk. Typically that number is about 3-4mm more than what it is at the beginning of surgery. We are also able to judge the approximate size of the cage in other dimensions based on preoperative MRI and CT scan that most patient's have before surgery.

[@iotanb1772]

Dr.Armaghani… I cant believe fusions are still preformed knowing the long term cons vs pros🙁 but its a very lucrative practice that allows rich surgeons to take their families on nice vacations, while poor people suffer life long irreversible side effects/complications. Fusion should be used if you are about to die after breaking your neck in a car accident, nothing less than that.

[@ChristineCasey-kw5pj]

What if u smoke

[@breezegeier9475]

Go Gators!

[@ArmaghaniSpine]

ALWAYS!

[@shark180]

Instructions unclear, took out the wrong disc...

[@Polecat-qz5om]

I just had this procedure. It went very well. Thank you Dr. armaghani.!❤️‍🩹

[@ArmaghaniSpine]

Wonderful!

[@ramcotex]

@@ArmaghaniSpine How do you choose the patients for this surgery.. what is the criteria? Can you list some of the important ones ?

[@PortlandSara]

Hi! It’s been 3 months since your comment. How are you feeling? I’m having this surgery next month.

[@Polecat-qz5om]

@@PortlandSara hey Sara. Ugh sorry you have to go through this nightmare too. I am doing extremely well though. I had grade 2 spondy and I was on my way to being in a wheelchair. I lost so much weight and was 110 pounds when I got to surgery. I have been gaining all my muscle, strength and energy back. They did the minimally Invasive surgery which helps keep you from having to have revisions later on. My doctor told me it was a less than 5% chance and I believe him whole heartedly. As we age we may or may not have more issues but by that time well all be old right?? I k ow it is scary. It was the scariest thing I ever went through but I’m so much better. I had a double level MI 360 so I am still healing but soooo much better. Good luck 🍀

[@lorenamartinez9962]

@@PortlandSara hi! How did your surgery go ? I’m having the same surgery in 2 months ☺️