A comparative study of the effects of oblique lateral lumbar interbody fusion and modified posterior lumbar interbody fusion under the Quardrant channel in the treatment of lumbar spinal stenosis with lumbar instability

English Keywords:Lumbar spinal stenosis  Oblique lateral interhody fusion  Minimally invasive surgery  Posterior lumbar interbody fusion

English Abstract:

  【Abstract】 Objectives: To compare the clinical efficacy of modified posterior lumbar intervertebral fusion (misPLIF) under the Quardrant channel and oblique lateral lumbar intervertebral fusion(OLIF) in the treatment of lumbar spinal stenosis with lumbar instability. Methods: Seventy-eight patients with lumbar spinal stenosis and lumbar instability treated from August 2016 to December 2017 were divided into two groups. Group A, 36 cases were treated with OLIF surgery, and group B, 42 cases were operated with misPLIF surgery. There was no difference significantly in age, genger, course of disease, bone mineral density, body mass index(BMI), complications and surgical segment between the two groups. Patients in both groups were followed up for 2 years. Comparison of trauma indicators[operation time, bleeding volume, postoperative hemoglobin(Hb) reduction, hospital stay], clinical efficacy indicators[pain visual analogue score(VAS), Oswestry dysfunction index(ODI)] and imaging indicators(vertebral space height, spinal canal sagittal diameter, and interbody fusion rate) between the two groups was performed, and statistical analyses were conducted. Results: The operations were successfully completed in both groups. There were no nerve injury, paralysis, and other serious complications found in the two groups. The incidence of short-term postoperative complications in group A was lower than that in group B, and the difference was statistically significant(P＜0.05). The parameters of operation time(69±27min), bleeding volume(38±14ml), hemoglobin decrease(11.0±2.5g/L), and postoperative hospital stay(4.3±1.5d) were lower in group A than in group B(113±33min, 215±48ml, 29.0±6.3g/L, 7.1±2.1d). The difference was statistically significant(P<0.05). The VAS scores at preoperation and postoperative 2d, 2w, 3 months, half a year, 1 year, 2 years were: group A(7.35±2.84, and 2.78±1.26, 2.48 ±1.21, 2.23±1.29, 1.63±1.29, 1.60±0.97, and 1.53±0.87); group B(7.43±2.66, and 4.12±1.84, 3.78±1.46, 2.81± 1.31, 2.11±1.31, 1.91±0.90, and 1.84±0.90). At 2 days and 2 weeks after surgery, the VAS scores of group A were significantly lower than that of group B(P<0.05). The ODI scores before surgery and at 3 months, 1 year, and 2 years after surgery were: group A [(68.45±16.21)% and (33.13 ±11.12)%, (25.23±8.15)%, and (24.36±6.43)%], and group B [(67.62±15.23)% and (35.27±10.85)%, (28.17±9.35)%, and (26.58±7.51)%], and the difference was not statistically significant(P>0.05). The height of the anterior/posterior source intervertebral space at before and 3d, half a year, and 2 years after surgery were: group A(14.11±1.56/7.36±1.28mm and 18.52±2.11/10.13±1.16mm, 16.67±2.07/8.98±1.38mm, 16.61±2.11/8.79±1.41mm), and group B(13.61±2.1/56.67±1.54mm, 15.65±2.55/8.87±2.11mm, 14.83±2.23/8.11±1.97mm, 14.01±2.29/8.13±1.88mm). The height of the intervertebral space in group A was bigger than group B, and the difference was statistically significant(P<0.05). Before and 3 days and half a year after operation, the sagittal diameter of the spinal canal were: group A(10.31±1.39mm and 13.21±2.13mm, 13.82±2.52mm), the parameters of which were smaller than group B(9.86±1.12mm and 17.33±2.25mm, 15.82±2.31mm) with a statistical difference(P<0.05). The intervertebral fusion rate was 94.44% in group A and 92.86% in group B, and the difference was not statistically significant(P>0.05). Conclusions: OLIF is a satisfactory treatment for lumbar spinal stenosis combined with lumbar instability and consistent with misTLIF. OLIF was better than misPLIF in pain scores and recovery of intervertebral space height with less bleeding and less trauma.