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Clin Orthop Relat Res. 2017 January; 475(1): 288.
Published online 2016 November 7. doi:  10.1007/s11999-016-5149-9
PMCID: PMC5174071

Letter to the Editor: The Oblique Anterolateral Approach to the Lumbar Spine Provides Access to the Lumbar Spine With Few Early Complications

To the Editor,

We read the article by Mehren and colleagues [2] with great interest. In their study, the authors found that the risk of vascular complications after oblique lumbar interbody fusion is lower compared to the reported risk for anterior midline approaches. Additionally, the risk of neurologic complications after oblique lumbar interbody fusion is lower than what has previously been reported using the extreme lateral transpsoas approach.

The study observed five superficial (0.62%) and six deep (0.74%) hematomas [2]. Still, questions remain. We do not know the levels assigned to risk of retroperitoneal hematoma and infection. Additionally, we were curious as to why the transmuscular approach may have a slight increase of postoperative retroperitoneal hematomas [1].

In their study, the authors suggest that the oblique psoas-sparing approach is lower than the risk of vascular complications with the midline approach, which ranges from 1.9% to 15% [2]. This is likely due to use of access lateral to the abdominal vessels with the oblique psoas-sparing approach. All three vessel lacerations in the series involved the L4–L5 segment, and the authors recommend careful and meticulous preparation and more posterior dissection of the anterior border of the psoas muscle [2]. We agree with the authors that there is no relationship between the risk of vascular complications and the oblique psoas-sparing approach [3].

Footnotes

(RE: Mehren C, Mayer HM, Zandanell C, Siepe CJ, Korge A. The Oblique Anterolateral Approach to the Lumbar Spine Provides Access to the Lumbar Spine With Few Early Complications. Clin Orthop Relat Res. 2016;474:2020–2027).

Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request.

The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR ® or The Association of Bone and Joint Surgeons®.

References

1. Kim JS, Choi WS, Sung JH. 314 minimally invasive oblique lateral interbody fusion for L4-5: Clinical outcomes and perioperative complications. Neurosurgery. 2016;63:190–191. doi: 10.1227/01.neu.0000489803.65103.84. [PubMed] [Cross Ref]
2. Mehren C, Mayer HM, Zandanell C, Siepe CJ, Korge A. The oblique anterolateral approach to the lumbar spine provides access to the lumbar spine with few early complications. Clin Orthop Relat Res. 2016;474:2020–2027. doi: 10.1007/s11999-016-4883-3. [PMC free article] [PubMed] [Cross Ref]
3. St. Clair S, Tan JS, Lieberman I. Oblique lumbar interbody fixation: A biomechanical study in human spines. J Spinal Disord Tech. 2012;25:183–189. [PubMed]

Articles from Clinical Orthopaedics and Related Research are provided here courtesy of The Association of Bone and Joint Surgeons