Complications and prevention strategies of oblique lateral interbody fusion in the treatment of degenerative lumbar disease

English Keywords:Oblique lateral interbody fusion  Degenerative lumbar disease  Complications  Interventions

English Abstract:

  【Abstract】 Objectives: To summarize the complications and interventions of oblique lateral interbody fusion(OLIF) in the treatment of degenerative lumbar disease. Methods: A total of 78 patients treated with OLIF in our hospital from July 2016 to February 2018 were retrospectively studied, including 37 males and 41 females. The average age was 54.2±7.9 years old(45-78 years old). The average follow-up period was 18.3±4.1months(13-36 months). There were 25 cases of degenerative lumbar spinal stenosis(32.1%), 23 cases of degenerative lumbar scoliosis(29.5%), 18 cases of degenerative lumbar spondylolisthesis(23.1%), and 12 cases of discogenic low back pain(15.4%). Operative segments were as follows: L2/3 in 31 cases, L3/4 in 47 cases, L4/5 in 37 cases. There were 52 cases of single segment fusion, 15 cases of double level fusion and 11 cases of three level fusion. Six patients received posterior pedicle screw fixation in the first or second stage, and 72 patients did not receive posterior pedicle screw fixation. Statistical analysis was used to analyze the operation time, bleeding loss, intraoperative and postoperative complications. Results: All patients completed the operation successfully and the average operation time was 130±55min(45-351min). The average intraoperative blood loss was 118±76ml(50-2500ml). Complications were observed in 18 patients. Of the intraoperative complications, 2 cases with endplate injury received posterior screw fixation in one-stage surgery, and no complications occurred at the last follow-up; 1 case had segmental artery injury and was treated by intraoperative ligation and no further abnormal manifestations occurred after the surgery; 1 case of left common iliac vein injury, which was repaired after using hemostatic materials and blood transfusion after the operation. The lower limb swelling occurred and subsided after affected limb elevation and anticoagulation; 1 case of peritoneal injury received intraoperative repair and intestinal function recovered the next day after operation. Of the postoperative complications, 4 cases of cage subsidence or shifting and all of them were treated with posterior screw fixation in the second stage; 3 cases of pain and numbness in front of the thigh were treated with neurotrophic drugs and the symptoms were significantly improved in 1 week; 2 cases of lower limbs abnormal skin temperature and sensation received neurotrophic therapy and recovered during the 4 months follow-up; 2 cases of asymptomatic pseudarthrosis received no special treatment; 1 case of incomplete intestinal obstruction improved after fasting, exhausting and taking chathartic; 1 case of postoperative superficial incision infection recovered after debridement, dressing change and anti-infection. Conclusions: There were some exactly intraoperative and postoperative complications in OLIF surgury and active symptomatic treatment had a good prognosis.