Hamid Abbasi, MD, PhD, is a board-certified neurosurgeon and CMO of Inspired Spine, headquartered in Burnsville, Minn.
Inspired Spine places a strong emphasis on minimally invasive approaches to spine surgery, particularly oblique lateral lumbar interbody fusion, which Dr. Abbasi believes is one of the most innovative treatments available for lumbar pain conditions.
OLLIF is intended for patients with degenerative disc disease, herniated discs, spondylolisthesis, scoliosis and spinal stenosis. Surgeons at Inspired Spine have completed nearly 1,000 procedures using the technology, including outpatient surgeries.
However, despite OLLIF's minimally invasive approach and low risk of complications as illustrated in a recent study, it hasn't been adapted as a widespread standard of care in the spine community.
For a single-level OLLIF, the mean surgery time reported was 56.6 ± 37.7 minutes, with a blood loss of 42.2 ± 31.1 mL and fluoroscopy time of 198.8 ± 87.2 seconds.
OLLIF uses a 15mm incision resulting in minimal blood loss and preserves muscles and the adjacent tissue. It is designed to heighten the disc and limit disc movement.
Dr. Abbasi teaches the OLLIF procedure nationally and internationally and attributes its lack of popularity among spine surgeons to its challenging learning curve. "The results are solid but it's not catching up because of the learning curve. Surgeons don't want to go back to school to learn it," Dr. Abbasi said. "That made us create our own surgical education center and get the word out."
Roughly 400 spine surgeons are trained in OLLIF and 90 percent of them quit after five procedures, according to Dr. Abbasi. Inspired Spine opened its fellowship program in March, where fellows explore minimally invasive procedures for the lumbar, thoracic, and cervical spine including OLLIF, DLIF and direct thoracic interbody fusion.
"I think it is no different than when general surgeons moved from open surgery to laparoscopy," Dr. Abbasi said. "You have to have somewhere between 20 and 40 cases before you have truly mastered this procedure."
In a February 2019 single-surgeon, multi-hospital study, "Clinical and Radiological Outcomes of Oblique Lateral Lumbar Interbody Fusion," Dr. Abbasi and researchers evaluated 303 OLLIF operations on 568 surgical levels to determine the procedure's safety and efficacy in lumbar spinal fusion.
Researchers found that the average surgery time for a one-level spinal fusion using the OLLIF technique was 52 minutes. The average blood loss reported was 42 mL — approximately 10 percent compared to open procedures on average — and the mean hospital stay was 2.2 days.
The study demonstrated OLLIF's ability to reduce OR time as it avoids osteotomies, doesn't require direct visualization and the patient doesn't need to be repositioned.
Of the 303 patients included in the study, six with single-level procedures and four with two-level procedures returned home on the day of the surgery.
"Every minute you spend on surgery and anesthesia, you're adding to the risk of complications in surgery," Dr. Abbasi said. "People that spend less than two hours in this surgery have half of the complications than patients who spend more than two hours. Every 30 minutes adds 17 percent more combined risk to the surgery."
Inspired Spine presented a study on the economic benefits of OLLIF at the Spine Summit 2017 in Las Vegas, with researchers demonstrating that performing OLLIF instead of transforaminal lumbar interbody fusion could save the U.S. healthcare industry around $3 billion annually.
The average procedure is performed in 40 minutes with 96 percent of patients walking within 24 hours of the procedure, according to data presented by Dr. Abbasi.
In the U.S., 31 million people experience low-back pain with over $90 billion per year being spent on low-back pain alone, according to the 2017 Global Burden of Disease study.
More than 1.2 million spinal surgeries are performed each year, including spinal fusion and decompression, or discectomy, surgery, according to the National Center for Health Statistics. Lumbar spinal fusion surgeries have seen a significant increase in the past decade, ranging from $60,000 to $110,000 per procedure.
With such high costs of spinal fusion procedures in the U.S., the prevailing objective of spine surgeons and healthcare organizations is to seek more cost-effective approaches to surgery and reducing OR time without sacrificing quality of care.
"Bringing a game changer is always difficult and that's why we need to bring this to the patient," Dr. Abbasi said. "To bring this technique to a core group of people who will truly benefit from this change in standard of care."