Early clinical efficacy of oblique lateral interbody fusion combined with lateral fixation for lumbar intervertebral infection

English Keywords:Lumbar intervertebral infection  Oblique lateral interbody fusion(OLIF)  Minimally invasive  Clinical protocols

English Abstract:

  【Abstract】 Objectives: To investigate the early clinical outcomes of oblique lateral interbody fusion(OLIF) combined with lateral fixation for the treatment of lumbar intervertebral infection. Methods: Twelve cases(8 males, 4 females) with lumbar intervertebral infection that underwent OLIF combined with lateral fixation from December 2014 to December 2017 were retrospectively reviewed, with a mean age of 56.5±13.0 years(range 35-73 years). The distribution of operative level: L1/2 in 1 case, L2/3 in 3 cases, L3/4 in 6 cases and L4/5 in 2 cases. After operation, anti-infective treatment was given according to pathological results and drug sensitivity test, and the erythrocyte sedimentation rate and C-reactive protein were monitored to evaluate the condition of disease control. Clinical efficacy were comprehensively evaluated by visual analogue scale(VAS), Japanese Orthopedic Association(JOA) scores and radiographic measurements. Results: The operation time was 96-164mins, with a mean time of 122±9mins. The intraoperative blood loss was 210-550ml, with a mean value of 290±22ml. In 3 patients with preoperative neurological defects, Frankel grade was improved from grade D preoperatively to grade E postoperatively indicating their neurological functions were restored. The VAS score decreased from 8.4±2.7 preoperatively to 1.5±0.6 at final follow-up. The JOA score showed that the treatment was effective in all patients, including excellent in 8 cases and good in 4 cases, with an overall excellent and good rate of 100%. The segmental height and lordosis were all well restored after operation, but different degrees of loss were founded during the follow-up. X-ray and CT scan performed at 6 months after operation showed 11 cases of grade I fusion, and 1 case of grade II fusion, with no pseudoarthrosis formation nor internal fixation loosening or fracture. There was 1 case of ipsilateral hip flexor weakness, and 1 case of contralateral thigh numbness, the symptoms were relieved within 2 weeks. Conclusions: Oblique lateral interbody fusion(OLIF) combined with lateral fixation was clinically effective for lumbar intervertebral infection, especially for infection mainly involved in anterior and middle spinal columns.