A Staged-OLIF approach can minimize construct lengths in adult spinal deformity- A case series and literature review

Adult Spinal Deformity (ASD) is one of the challenging conditions to treat for spine surgeons. One of the important dilemmas in the management of these patients is the decision on the number of levels of instrumentation and the overall length of the construct. OLIF has the advantage of providing a minimally invasive approach to address this complex pathology also allowing us to stage the procedure and thus help clinicians reassess if the patient requires an additional decompression, long fusion lengths, or need for osteotomies.

Our study aims to evaluate the possibility of minimizing the construct length following a staged OLIF approach in ASD patients and also to analyze the clinical and radiological outcomes following a staged OLIF surgery.

We present three cases of ASD, where the patients had a significant imbalance in either the coronal/sagittal profiles, and by using a staged approach, the surgeon was able to reduce the construct lengths and also operate on these deformities using an all Minimally Invasive Surgery (MIS) approach.

Overall sagittal and coronal profiles improved in all three cases with satisfactory fusion rates and VAS scores (back pain) post-operatively. Two of the three patients had an all-MIS approach (OLIF with MIS Ponte osteotomy and robotic guided pedicle screw instrumentation) and in one patient a four-rod construct was preferred to improve the stability. No complications were observed during a mean follow-up period of 4 years.

A staged approach in ASD (lateral OLIF and posterior instrumentation) is a valuable surgical strategy for better correction of the coronal and sagittal plane deformities with relatively lesser construct length. It reduces the problems associated with prolonged anesthesia, in addition, it helps the surgeon in reassessing the pelvic parameters, thereby helping to decide on the need for additional osteotomies during the second procedure.