Clinical outcome of OLIF in the treatment of symptomatic ASD after lumbar fusion

English Keywords:Oblique lumbar interbody fusion  Adjacent segment degeneration  Posterior lumbar interbody fusion  Lumbar degenerative disease  Clinical outcomes

English Abstract:

  【Abstract】 Objectives: To explore the short-term clinical outcome of oblique lumbar interbody fusion (OLIF) in symptomatic adjacent segment degeneration (ASD) after lumbar fusion. Methods: Retrospective studied 62 patients with symptomatic ASD after lumbar fusion treated in our hospital from January 2015 to July 2018 . 38 patients were treated with OLIF (16 males and 22 females, aged 39-74 years, mean age 58.2±14.5 years), and 24 patients with PLIF (13 males and 11 females, aged 41-70 years, mean age 56.6±11.7 years). The perioperative condition of the patients was evaluated by recording the operation time, intraoperative blood loss, and complications. The clinical efficacy of both groups were assessed by comparing the scores of low back pain and visual analogue scale (VAS) and Oswestry disability index ODI recorded before surgery, 3 months after, and the final follow-up. The radiological improvements were compared by measuring intervertebral disc height (IDH), intervertebral foramen height (IFH) and intervertebral foramen area (IFA) on X-ray before and at the final follow-up. Results: The follow up periods for the 62 patients were from 8 to 36 months (average, 18.4±8.2 months). The mean operation time and blood loss in group OLIF were significantly less than those in group PLIF (81.2±17.4min vs 127.8±26.2min, 129.2±15.2ml vs 205.6±23.8ml, P<0.05). No intraoperative complications such as injuries on blood vessels, nerves, peritoneum and organs were observed in OLIF group. There were 2 cases of cerebrospinal fluid leakage in the PLIF group. The clinical outcome of all the patients improved during the follow-up. In the OLIF group, the mean VAS scores of back pain, lower limb pain and ODI were 2.39±0.82, 1.43±0.58 and (20.61±4.24)% at 3 months after the operation; and 1.97±0.66, 1.22±0.75 and (13.47±4.56)% at the final follow-up. In the PLIF group, the mean VAS scores of back pain, lower limb pain and ODI were 2.75±1.28, 1.54±0.79 and (21.88±5.94)% at 3 months after; and 1.60±1.14, 1.61±1.15 and (15.12±4.71)% at the last follow-up. The mean VAS scores and ODI at 3 months after operation and final follow-up were improved significantly (P<0.05) in both groups comparing to the preoperative datas, yet there was no statistical difference (P>0.05) between the two groups. At final follow-up, IDH, IFH and IFA were 10.54±0.88mm, 20.86±2.67mm and 206.24±11.45mm2 in OLIF group and were 8.52±1.27mm, 23.18±2.26mm and 227.74±12.89mm2 in PLIF group. Both groups saw significantly increase in IDH, IFH and IFA compared with those before operation(P<0.05), but there was no statistically significant difference between the two groups(P>0.05). Conclusions: OLIF and PLIF have the same clinical outcomes in the treatment of symptomatic adjacent segment degeneration after lumbar fusion, but OLIF has advantages of shorter operation time and less complications.