Early clinical results and complications of oblique lumbar interbody fusion for degenerative lumbar diseases

English Keywords:Oblique lumbar interbody fusion  Complications  Minimallyinvasive surgery  Degenerative lumbar diseases

English Abstract:

  【Abstract】 Objectives: To investigate the early clinical results and complications associated with degenerative lumbar diseases treated by performing oblique lumbar interbody fusion(OLIF) based on the perioperative parameters and follow-up data. Methods: From November 2014 to February 2017, total 86 consecutive patients undergoing OLIF were retrospective analyzed. There were 38 males and 48 females with an average age of 52.6±6.1 years(42-70 years). The diagnosis included lumbar spondylolisthesis in 41 cases, lumbar instability in 14 cases, discogenic low back pain in 14 cases, adjacent segmental disease after posterior lumbar fusion in 10 cases, and adult lumbar scoliosis in 7 cases. Sixty one patients underwent OLIF with bilateral percutaneous pedicle screw fixation. Twenty five received stand-alone OLIF. Single-level OLIF was performed in 79 cases, two-level OLIF in 5 cases, three-level OLIF in 2 cases. All intraoperative parameters such as operation time and estimated blood loss, and intra/postoperative complications only included the measurement and findings related to the OLIF procedure. The early clinical results and complications were assessed and analyzed based on the clinical data related to the OLIF procedure. The influences of vertebral osteoporosis on endplate fractures and cage subsidence, and the effect of stand-alone OLIF or combined with percutaneous pedicle screw fixation on cage subsidence and interbody fusion were analyzed, respectively. Results: The mean operation time was 41.7±11.3min. The average blood loss was 20.5±14.3ml. The complications included donor site pain in 17 cases(19.8%), thigh numbness/pain in 11 cases(12.8%), end-plate fracture in 10 cases(11.6%), psoas/quadriceps weakness in 4 cases(4.7%), sympathetic nerve injury in 2 cases(2.3%), paralytic ileus in 1 case(1.2%) and intervertebral infection in 1 case(1.2%). No permanent neurological sequelae were observed in these series. Eighty six patients achieved more than six months follow-up, and the average follow-up period was 13.4±4.8 months. The back pain VAS scores and ODI decreased respectively from 6.1±2.5 before surgery to 1.3±0.8 at final follow-up(P=0.003) and from (32.6±10.1)% before surgery to (14.2±4.5)% at final follow-up(P=0.004). Total fusion rate was 91.9%(79/86) at final follow-up. Compared to patients without osteoporosis, severe vertebral osteoporosis significantly increased vertebral endplate fracture risk(P=0.003), and significantly increased cage subsidence at final follow-up. Stand-alone OLIF or combined with percutaneous pedicle screw fixation had no significant effect on cage subsidence and interbody fusion(P=0.199). Conclusions: The indications of OLIF for degenerative lumbar diseases are limited, this technique may obtain good early clinical outcomes and suffer from complication risk related with anterior lumbar surgery. Lumbar osteoporosis may significantly increase complication rates during procedures.