Comparative analysis of the clinical efficacies of three surgical methods for the treatment of adjacent segment disease after lumbar fusion

English Keywords:Adjacent segment disease  Spinal fusion  Surgical method  Clinical effect

English Abstract:

  【Abstract】 Objectives: To analyze the clinical effects of oblique lumbar interbody fusion(OLIF), posterior cortical bone trajectory(CBT) screw fixation and midline lumbar interbody fusion(MIDLIF) and traditional posterior lumbar interbody fusion(PLIF) in the treatment of adjacent segment diseases(ASD) after lumbar fusion. Methods: The clinical data of 60 patients with adjacent segment diseases after lumbar fusion treated in our hospital between May 2013 and September 2020 were analyzed retrospectively, including 31 males and 29 females, aged 40-73 years(57.4±13.8 years) old. The interval from the first fusion fixation for all the patients was 6-84 months(56.3±20.8 months). Among them, 26 cases were with adjacent segment lumbar disc herniation, 23 with lumbar spinal canal stenosis, and 11 with lumbar spondylolisthesis and unstable. According to different surgical methods, the patients were divided into OLIF group(n=16), MDLIF group(n=20), and PLIF group(n=24). The operation time, intraoperative blood loss, hospital stay, and perioperative conditions of the three groups of patients were recorded. The visual analogue scale(VAS) and the Oswestry disability index(ODI) were used to evaluate low back and leg pain and lumbar function at preoperation, 3 months after surgery, and final follow-up. The interbody disc height(IDH), interbody foraminal height(IFH), and interbody foraminal area(IFA) were measured on anteroposterior lateral X-ray of the lumbar spine at preoperation and 3 months after surgery. Results: There were no statistically significant differences in age, gender, lesion segment, preoperative VAS score and ODI among the three groups of patients(P>0.05). The intraoperative blood loss, operation time, and hospital stay were 125.6±14.5ml, 92.3±13.5min, and 6.3±1.2d in OLIF group, 220.4±15.2ml, 120.6±11.4min, and 10.5±1.4d in MIDLIF group, and 218.4±12.5ml, 115.4±10.7min, and 10.4±1.4d in PLIF group. The intraoperative blood loss, operation time, and hospital stay of OLIF group were significantly lower than those in MIDLIF group and PLIF group(P<0.05), while there was no significant difference between those of MIDLIF group and PLIF group(P>0.05). The patients were followed up for 10-32 months(20.5±5.8 months). In the OLIF group, the VAS scores of low back pain and lower limb pain and ODI were 2.43±0.52, 2.37±0.63 and (20.47±3.10)% at 3 months after operation, and 2.10±0.52, 2.05±0.31and (14.14±2.41)% at the final follow-up; In the MIDLIF group, those parameters were 2.84±0.67, 1.93±0.36 and (21.89±3.07)% at 3 months after operation, and 1.94±0.55, 1.75±0.20 and (15.32±2.11)% at the final follow-up; In the PLIF group, those were 3.22±0.82, 2.24±0.42 and (23.51±3.41)% at 3 months after operation, and 1.83±0.49, 1.92±0.28 and (16.40±2.10)% at the final follow-up. The low back pain and lower limb pain VAS scores and ODI at 3 months postoperatively and final follow-up of the three groups significantly improved than those before operation[OLIF group, 7.47±1.03, 7.55±1.04 and (70.63±5.46)%; MIDLIF group, 7.50±0.99, 7.46±1.10 and (69.89±5.55)%; PLIF group, 7.51±1.01, 7.53±1.11 and (71.05±5.71)%](P<0.05), while there was no significant difference between the three groups at the same time point(P>0.05). At 3 months after operation, the IDH, IFH, and IFA were respectively 10.47±0.86mm, 21.41±2.57mm, 210.57±11.34mm2 in OLIF group; 9.11±0.79mm, 18.70±2.62mm, and 196.41±13.40mm2 in MIDLIF group; and 9.26±0.91mm, 19.37±2.51mm, 193.42±12.12mm2 in PLIF group. The IDH, IFH, and IFA of the three groups at three months after operation significantly improved compared with those before operation(OLIF group, 5.86±0.76mm, 14.52±2.31mm, and 135.84±10.41mm2; MIDLIF group, 5.90±0.69mm, 14.43±2.27mm, and 127.10±10.64mm2; PLIF group, 5.79±0.81mm, 14.39±2.40mm, and 126.47±10.55mm2)(P<0.05), while there was no statistical significance between the three groups at the same time point(P>0.05). There was no significant difference in perioperative complications among the three groups(P>0.05). Conclusions: OLIF, MIDLIF, and PLIF all achieved satisfactory clinical effects in the treatment of adjacent segment diseases after lumbar fusion surgery, while the operation time and hospital stay of OLIF were shorter and the intraoperative bleeding was less.