Poster Presentation 51st International Society for the Study of the Lumbar Spine Annual Meeting 2025

Use of Kirschner wires as self-retaining retractors in oblique lumbar interbody fusion at L5/S1 segment (#167)

Jiachen Lin 1 , Bowen Lv 1 , Yue Wang 1 , Yuzhu Zhang 1 , Yihe Hu 1
  1. The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, ZHEJIANG, China

INTRODUCTION

Minimal invasive oblique lumbar interbody fusion via lateral access route of the left common iliac vessels has been proposed as a novel approach for L5-S1 fusion (OLIF51). However, the use of traditional retractors or channel instruments during the procedure imposes a risk of blunt injuries on the fragile local vasculature. Here we aim to demonstrate a surgical method utilizing the Kirschner wires (K-wires) as self-retaining retractors in OLIF51 to provide safe, adequate and flexible retraction.

METHODS

After exposing the L5-S1 intervertebral space via the lateral corridor, we inserted a total number of 4-6 K-wires (2.5mm) manually into the L5 and S1 vertebrae to separate the surrounding soft tissues and obtain satisfied visualization on intervertebral disc (Figure A). Firstly, we use a K-wire to locate the intervertebral space via fluoroscopy. Two K-wires were then respectively implanted at the posterior part of the lower L5 endplate and upper S1 endplate, and bended posteriorly to retract major psoas muscles (1-2). Note that the implantation requires caution to avoid the intervertebral foramen and existing nerve roots. Subsequently, we dissected the soft tissue and vasculature attached to the vertebral column using the suction tip and bipolar electrocautery. Ligate or coagulate branches of iliolumbar vein or ascending lumbar vein if necessary. Another two K-wires were then implanted at the middle part of the vertebrae to anteriorly retract major vessels (iliac vein and its branches), peritoneum, and sympathetic plexus (3-4). We placed a surgical gauze pad in between the K-wires and soft tissue. Note that additional K-wires may be used to achieve better fixation on the anterior vascular structures (5-6). After K-wire fixation, standard OLIF procedure was performed. Finally we retracted the K-wires and use surgical fibrillar for coagulation. The neurovascular complications, operation time, intraoperative blood loss and other perioperative parameters were recorded and compared with OLIF51 using traditional channel retractors. All cases were performed by single surgeon with experience.

RESULTS

Written consent was obtained from each participant. Among the 48 cases enrolled in this study, there were 25 K-wire assisted OLIF51 cases (KA-OLIF group) and 23 cases using traditional retractor. None of the patients developed intraoperative or postoperative neurovascular injuries in KA-OLIF group. The operation time for lumbar fusion (20.88±5.85 vs 32.69±8.67 min, p < 0.001), intraoperative blood loss (21.40±9.67 vs 36.74±13.33 ml, p < 0.001), post-op drainage (16.4±8.89 vs 33.91±13.55 ml, p < 0.001) as well as C-reaction protein level (12.26±6.80 vs 39.10±18.55 mg/L, p < 0.001) were significantly reduced in KA-group compared with traditional retractor group.

DISCUSSION

Here we propose that K-wires can be used as self-retaining retractors in OLIF51 procedure. The details of the technique were described and illustrated. Our findings suggested that K-wire assistance in OLIF51 could provide safe and adequate exposure of the surgical field, and thus facilitate the procedure.

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  2. Berry, C. A., Thawrani, D. P. & Makhoul, F. R. (2021) Inclusion of L5-S1 in oblique lumbar interbody fusion-techniques and early complications-a single center experience, Spine J. 21, 418-429.
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