Efficacy analysis of posterior percutaneous pedicle screw distraction reduction and fixation combined with oblique lateral interbody fusion in the treatment of lumbar spondylolisthesis

English Keywords:Lumbar spondylolisthesis  Oblique lateral interbody fusion  Percutaneous pedicle screw  Minimally invasive

English Abstract:

  【Abstract】 Objectives: To explore the clinical effect of posterior percutaneous pedicle screw distraction reduction and fixation combined with oblique lateral interbody fusion(OLIF) in the treatment of lumbar spondylolisthesis. Methods: 30 patients with lumbar spondylolisthesis treated with posterior percutaneous pedicle screw distraction reduction and fixation combined with OLIF in our hospital from September 2018 to January 2021 were analyzed retrospectively. There were 9 males and 21 females, averaged 61.5±7.4 years old(44-76 years) and followed up for 13.3±5.1 months(8-26 months). The operative time, intraoperative blood loss, and postoperative complications were recorded, and the VAS scores of low back and leg pain, Oswestry disability index(ODI), and the scores of 36-item short-form health survey(SF-36) before operation, 1 week, 3, 6, 12 months after operation, and at the final follow-up were compared to evaluate the clinical efficacy. The foraminal height(FH), disc height(DH), slipping percentage(SP), segmental lordosis(SL), and lumbar lordosis(LL) of the operational segment were measured on X-ray images before operation, at 1 week and 6 months after operation, and at the final follow-up. The axial diameter and cross-sectional area of dural sac were measured on MRI images, and intervertebral fusion was evaluated by CT scan. Results: The average operative time was 105．0±20．8min and average intraoperative blood loss was 55．8±20．6ml. 1 case occurred segmental vascular injury and bleeding during operation, and 4 cases had lateral thigh pain and hypoesthesia after operation, whose symptoms completely disappeared at 1 month after operation. No endplate injury, peritoneal injury or ureteral injury occurred during operation, nor were there complications such as lower limb dyskinesia, infection or cage subsidence or displacement. The VAS scores, ODI, and SF-36 scores at 1 week, 3, 6, and 12 months, and at the last follow-up were improved greatly than those before operation with statistically significant differences(P<0．05), while there were no significant differences between those at each postoperative follow-up time points(P>0．05). The FH, DH, SP, SL, LL, axial diameter and cross-sectional area of dural sac at 1 week and 6 months after operation and the final follow-up were improved significantly comparing with those before operation with statistical differences(P<0．05), while no statistical differences were there between those at each postoperative time points(P>0．05). The interbody fusion rate was 100% in all cases between 6 months and the last follow-up. Conclusions: The clinical effect of posterior percutaneous pedicle screw distraction reduction and fixation combined with OLIF in the treatment of lumbar spondylolisthesis is satisfactory, which can achieve accurate reduction of lumbar spondylolisthesis, correct the lumbar lordosis and segmental lordosis effectively. With a high rate of interbody fusion and satisfactory indirect decompression of spinal canal, it is a safe and effective operation for the treatment of lumbar spondylolisthesis.