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The main advantage of Oblique Lumbar Interbody Fusion (OLIF) is its ability to provide safe access to the lumbar spine while being a robust interbody fusion technique through a minimally invasive approach. This study reviews the postoperative complications of OLIF, offering a comprehensive understanding of its advantages and disadvantages. A total of 27 studies with 1275 patients were shortlisted based on our selection criteria. Complications were categorized into intra-operative, immediate post-operative, and delayed post-operative and were interpreted based on surgical procedure into stand-alone OLIF, OLIF with posterior stabilisation, and unspecified. Major complications exhibited a pooled prevalence of just 1.7%, whereas the overall pooled prevalence of complications was 24.7%. Among the subgroups, the stand-alone subgroup had the lowest prevalence of complications (14.6%) compared to the unspecified subgroup (29.6%) and the OLIF L2-5 with posterior stabilisation subgroup (25.8%). Similarly, for major complications, the stand-alone subgroup had the lowest prevalence (1.4%), while the OLIF L2-5 with posterior stabilisation subgroup (1.8%) and the unspecified OLIF L2-5 subgroup (1.6%) had higher rates. However, the differences were not statistically significant. In conclusion, the rate of major complications after OLIF is minimal, making it a safe procedure with significant benefits outweighing the risks. The advantages of OLIF L2-5 with posterior stabilisation over stand-alone OLIF L2-5 is a subject of discussion. [ABSTRACT FROM AUTHOR]

Surgery for ossification of the ligamentum flavum (OLF) comes with a relatively high risk of dural tear. We report a 50-year-old woman, who presented with symptomatic spinal stenosis from OLF at T11–T12 and lower lumbar spondylosis for which a single stage posterior decompression and instrumented fusion of both sites was done. Removal of the OLF resulted in a small dural tear with intact arachanoid which was covered using a fibrin sealant. In the first post-operative day, the patient's neurology started deteriorating. An MR scan was done to look for hematoma. It showed the spinal cord herniating out of the thecal sac at the operated level. Emergency re-operation was done to reduce the herniation and the dural defect was repaired. The patient gradually recovered to her best functional status. Based on this experience, we advise primary repair of inadvertent durotomies. [ABSTRACT FROM AUTHOR]

Ossification of the yellow ligament (OYL) or ligamentum flavum, usually occurs in the thoracic spine. Focal OYL occurring in the cervical spine is considered rare and is sparsely reported in the literature. We came across a 30-year-old male patient with progressive left upper limb and bilateral lower limb weakness over a period of 3 months, associated with an unsteady gait. Clinical examination revealed bilateral generalized hyper-reflexia in both upper and lower limbs, inverted supinator jerk, Hoffman’s sign and clonus. Myelopathy due to cord compression was suspected and further investigations were done. MRI and CT scans revealed a bony mass in relation to the C6 spinous process projecting anterosuperiorly and narrowing the cervical spinal canal causing cord signal changes from C4 to C6 levels. In view of the deteriorating neurological status, immediate surgery in the form of decompression and posterior stabilization from C4-C6 was performed. Patient gradually recovered after surgery and attained full functional status. We report this case considering the unusual location of OYL and its successful management.

Spinal metastasis of neuro-endocrine tumours (NETs) usually arise from a primary in the lung. We encountered such a patient with NET metastasis to T6 vertebra causing severe cord compression. Considering the neurological status, immediate decompression surgery along with T3-T8 posterior stabilization was done. Early recurrence of the tumour causing near total obliteration of the spinal canal leading to significant neurological compromise was noted within one month of surgery. A second surgery at this stage was avoided due to the risk involved and concurrent chemo-radiotherapy was initiated. The tumour was sensitive to chemo-radiotherapy and rapid resolution was noted on subsequent follow-up visits. With appropriate rehabilitation, patient regained full power to become ambulant with support. This case report highlights a rare, early and aggressive recurrence of metastatic vertebral NET following index surgery which was effectively managed with chemo-radiotherapy.

Ossification of the posterior longitudinal ligament (OPLL) most commonly occurs in the cervical spine, usually involving two to three segments; however, the disease has the potential to occur anywhere in the spine. We encountered a fifty-one year old male with progressive unsteadiness and bilateral lower limb weakness for a period of six months which eventually became worse resulting in inability to walk without assistance. Neurological examination revealed normal upper limb function; however, the lower limbs demonstrated motor dysfunction. Signs of myelopathy were elicited and the patient was subjected to detailed radiological evaluation. CT and MRI scans revealed an extensive cervico-thoracic continuous OPLL from C3 to T3 causing significant cord compression. In view of the deteriorating neurological status, extensive C3-T3 laminectomy with instrumented posterolateral fusion was done and the patient recovered without any immediate or delayed C5 palsy. This case highlights a rare occurrence or extensive OPLL involving eight segments at the cervico-thoracic region. This report also discusses surgical strategies for managing such extensive presentations and our technique to prevent C5 palsy.

Incidental durotomy during lumbar spine surgery is a commonly reported complication. Those presenting with cerebrospinal fluid (CSF) leak are usually recognized and repaired intraoperatively. In some circumstances, it may either be unrecognised or occur as a delayed complication. Such delayed occurrences cannot be predicted and its management remain a challenge to the surgeon, especially when it presents as a subdural effusion. We report a 55-year-old man who underwent mini open lumbar discectomy through left side for a prolapsed L4-L5 disc. Recurrent worsening radicular symptoms along with a palpable cystic swelling at the previous surgical site became eminent, three months after surgery. MRI revealed distinctive anterior translation of all rootlets with subdural fluid collection posterior to it, within a normally placed dura, extending from L1 to L5 levels. A concomitant pseudomeningocele with a fistulous tract was also evident. Draining of pseudomeningocele with widening of previous laminotomies revealed a dural defect of less than 0.5 cms that prompted the CSF leak. Subdural effusion was drained following which the defect was repaired with inlay polyester urethane dural substitute patch and augmented with fibrin sealant. Symptoms regressed and follow up was uneventful. Occurrence of sub-dural effusion in lumbar spine is inevitably uncommon. We advise to suspect this condition in patients with recurrent symptoms following satisfactory lumbar decompression surgeries. Recognising this condition, followed by appropriate drainage of subdural effusion and direct repair of the dural defect is highly recommended for a better prognosis.