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Background: The oblique lateral interbody fusion technique has received increasing attention for the treatment of degenerative disc disease in recent years. A series of complications have been reported, such as vascular injury, sympathetic chain injury, and transient psoas weakness, although it is regarded as a relatively safe technique., Case Presentation: A 55-year-old male patient of Han nationality was diagnosed with lumbar spinal stenosis and underwent standalone oblique lateral interbody fusion surgery under general anethesia. Three days after the operation, subcutaneous gas accumulation appeared in the left lower abdomen of the patient with no inflammatory reaction of the wound. He was treated with conservative management, and the retroperitoneal pneumatosis and subcutaneous emphysema had disappeared completely 1 month later., Conclusions: To date, this is the first reported case of retroperitoneal pneumatosis and subcutaneous emphysema related to oblique lateral interbody fusion surgery, which broadens the scope of the complications of oblique lateral interbody fusion surgery., (© 2021. The Author(s).)

Objective: To use computed tomography angiography to evaluate the regional anatomy of the lumbar segmental arteries (LAs) associated with the surgical field in oblique lateral interbody fusion (OLIF)., Methods: Computed tomography angiography images from 50 patients were reviewed. In the sagittal plane, distances from the LA to the upper and inferior edges of the vertebral body were measured in the anterior quarter of the anterior and median lines of the intervertebral disc (IVD). LAs were classified as types I-IV based on the zone in which they passed through the vertebral body., Results: The LA branch angles were acute (<90°) at L1-L3 and blunt (>90°) at L4-L5. The average distances from the LA to the upper and inferior edges of the vertebral body in the anterior quarter position revealed that La1.2 > Lb1.2 and Lb3.4.5 > La3.4.5. For the IVD of L1-L2, Lb1 < La2; IVD of L2-L3, Lb2 < La3; IVD of L3-L4, Lb3 > La4; IVD of L4-L5, Lb4 > La5. In zone I, the most frequent LA type was type IV at L1 (n = 41; 85.4%) and L2 (n = 42; 84.0%), type III at L3 (n = 20; 40.0%), and type II at L4 (n = 36; 80.0%) and L5 (n = 5; 83.3%). In zone II, the most frequent LA type was type III at L1 (n = 38; 79.2%), L2 (n = 39; 78.0%), L3 (n = 43; 86.0%), and L4 (n = 28; 62.2%), whereas type II was the most frequent LA type at L5 (n = 5; 83.3%). In zone III, type III was the most frequent LA type at L1-L4. In zone IV, type IV was the most frequent LA type at L3 (n = 44; 88.0%), L4 (n = 42; 93.3%), and L5 (n = 6; 100%)., Conclusions: The risk of LA injury during OLIF is the least when the cage is placed in zones II and III. Care is required during OLIF in zone IV of L3-L5. The fixation pin should be fixed on the upper edge of the lower vertebral body at L1-L2 and L2-L3, and on the lower edge of the upper vertebral body at L3-L4 and L4-L5., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: To elucidate the correlation between changes in spinal/pelvic sagittal parameters and clinical treatment outcomes after oblique lumbar interbody fusion (OLIF)., Methods: Eighty-two patients with lumbar degenerative disease (LDD) treated by OLIF were retrospectively analyzed. The visual analog scale (VAS) score and Oswestry Disability Index (ODI) score were compared before and after surgery. Disk height (DH) and various spinal/pelvic sagittal parameters, including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), and sagittal vertical axis (SVA), were measured preoperatively and at the last postoperative follow-up. The correlation between the changes in sagittal parameters before and after surgery and the clinical treatment outcomes were observed., Results: ODI score, VAS score, and DH were significantly better at the last follow-up compared with before surgery. The change in PI was not statistically significant before and after surgery. PT significantly decreased and SS and LL significantly increased after surgery. Significant linear relationships were found for several independent variables (difference in DH before and after surgery, postoperative LL, difference in LL before and after surgery, PI-LL match status, and SVA status) and the dependent variable ODI. The difference in DH before and after surgery showed the strongest correlation. The percentages of PI-LL match were 37% before surgery and 66% after surgery. The percentage of the normal SVA was 9% before surgery and 62% after surgery., Conclusions: OLIF for treatment of LDD had significant clinical outcomes, effectively restored the spinal/pelvic sagittal balance, and helped to improve the patients' clinical conditions., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: To investigate the anatomic relationship between ureter and oblique lateral interbody fusion access by using contrast-enhanced computed tomographic urography., Methods: Contrast-enhanced computed tomographic urography data of 234 patients were retrospectively analyzed. The angle of inclination (∠α) of bilateral ureters, the angle between bilateral surgical accesses (∠β), the insertion angle of surgical access (∠γ), and the angle between ureter and outer margin of ipsilateral surgical access (∠ε) at L2/3, L3/4, and L4/5 levels were measured and analyzed., Results: ∠α gradually increased from L2/3 to L4/5. ∠β gradually decreased from L2/3 to L4/5, and at each level the left-sided ∠β was larger than right-sided ∠β. ∠ε were positive at L2/3 and left-sided L3/4. The right-sided ∠ε at L3/4 and the bilateral sided ∠ε at L4/5 were negative, and the right-sided ∠ε at L4/5 had the largest absolute value., Conclusions: The bilateral ureters gradually descents from the lateral margin to the anteromedial margin on the surface of psoas major muscle. The range of bilateral surgical accesses for oblique lateral interbody fusion gradually decreases from L2/3 to L4/5, and the left-sided access is larger than the right-sided when at the same level. Ureters at the right-sided L3/4 level and bilateral L4/5 levels are at high risk of being injured. In particular, the right ureter at the L4/5 level is most likely to be injured., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: High morbidity has been reported with iliac crest bone graft harvesting; however, donor bone is typically necessary for posterior spinal fusion. Autograft bone combined with allograft may reduce the morbidity associated with iliac crest bone harvesting and improve the fusion rate. Our aim in this study was to determine the presence of complications, pseudarthrosis, non-union, and infection using combined in situ local autograft bone and freeze-dried cancellous allograft bone in patients undergoing posterior spinal fusion for the treatment of adolescent idiopathic scoliosis., Methods: A combination of in situ local autograft bone and freeze-dried cancellous allograft blocks were used in 50 consecutive patients with adolescent idiopathic scoliosis treated by posterior fusion and Moss Miami pedicle screw instrumentation. Results were assessed clinically and radiographically and quality of life and functional outcome was evaluated by administration of a Chinese version of the SRS-22 survey., Results: There were 41 female and 9 male patients included for analysis with an average age of 14.7 years (range, 12-17). All patients had a minimum follow-up of 18 months (range, 18 to 40 months). The average preoperative Cobb angle was 49.8 degrees (range, 40 degrees to 86 degrees ). The average number of levels fused was 9.8 (range, 6-15). Patients had a minimum postoperative follow-up of 18 months. At final follow-up, the average Cobb angle correction was 77.8% (range, 43.4 to 92.5%). There was no obvious loss in the correction, and the average loss of correction was 1.1 degrees (range, 0 degrees to 4 degrees ). There was no pseudarthrosis and no major complications., Conclusions: In situ autograft bone combined with allograft bone may be a promising method enhances spinal fusion in AIS treated with pedicle screw placement. By eliminating the need for iliac crest bone harvesting, significant morbidity may be avoided.

Study Design: A retrospective radiographic study on the type of surgically treated idiopathic scoliosis, with a prospective study on the reliability of the type-related fusion guide., Objectives: To identify and classify surgically treated idiopathic scoliosis, and define its related fusion levels by a new classification system., Summary of Background Data: Some classification methods for idiopathic scoliosis have been suggested. However, poor intraobserver reproducibility and interobserver reliability were experienced in these studies, and were not appropriate for guiding surgical planning., Methods: A total of 427 surgically treated idiopathic scoliosis cases were reviewed. Preoperative and postoperative standing anteroposterior, lateral, and preoperative supine side-bending radiograph were analyzed using the Scoliosis Research Society definition of scoliosis and curve apex. The resulting classification was tested for intraobserver reliability and interobserver reliability, and by 6 surgeons. Apical frequencies were determined for each type, and prospective surgical testing of the new type and its related fusion guide was performed., Results: Three major types and 13 subtypes were identified, of which the Peking Union Medical College type I accounted for 56.62%, type II 42.16%, and type III 1.22%. The interobserver reliability testing was 85% (kappa coefficient 0.832), while intraobserver reproducibility was 91% (kappa coefficient 0.898). Each type had its corresponding fusion levels. A prospective study of 152 cases was performed according to the classification. All of these cases were followed over 18 months, and no postoperative decompensation was noted., Conclusion: The Peking Union Medical College classification of idiopathic scoliosis is one system to combine each type with its corresponding fusion level, and it had much higher interobserver reliability and intraobserver reproducibility than the King system. Further prospectivestudies would help to clarify and expand this system.