Short-term efficacy comparison of oblique lateral interbody fusion versus crenel lateral interbody fusion combined with posterior percutaneous pedicle screw fixation for degenerative lumbar instability

English Keywords:Degenerative lumbar instability  Oblique lateral interbody fusion  Crenel lateral interbody fusion  Efficacy

English Abstract:

  【Abstract】 Objectives: To compare the short-term efficacy of oblique lateral interbody fusion(OLIF) with crenel lateral interbody fusion(CLIF) combined with posterior percutaneous pedicle screw fixation for degenerative lumbar instability. Methods: The clinical data of 30 patients with degenerative lumbar instability treated with OLIF or CLIF at The First Affiliated Hospital of Ningbo University and Sir Run Run Shaw Hospital of Medical College of Zhejiang University from June 2019 to June 2022 were retrospectively analyzed. The patients were divided into OLIF group and CLIF group, and both groups of patients underwent posterior percutaneous pedicle screw fixation 4 weeks after the first-stage surgery. OLIF group(18 cases) consisted of 7 males and 11 females, aged 69.9±7.9 years old, body mass index(BMI) 25.67±3.05kg/m2, 6 cases of 2-segmental lesions and 12 cases of 3-segmental lesions; CLIF group(12 cases) consisted of 4 males and 8 females, aged 66.5±8.6 years old, BMI 24.03±2.06kg/m2, 2 cases of 2-segmental lesions and 10 cases of 3-segmental lesions. Data of intraoperative bleeding, operative time, hospital stay, and postoperative complications were collected for both groups of the first-stage surgery, and visual analogue scale(VAS) of back and lower limb pain, Oswestry disability index(ODI) were performed before surgery and at 1 month, 6 months, and 1 year after the first-stage surgery. The disc height(DH) of the operated segment, lumbar lordosis(LL), and the cage subsidence height and angle between cage and coronal plane 1 year after the first-stage surgery were measured. All data were compared statistically between groups. Results: There were no statistical differences in age, gender, BMI, or number of lesion segments between the two groups(P>0.05), which were comparable. The operative time, intraoperative bleeding, and hospital stay for the first-stage surgery were 183.89±39.43min, 55.56±27.49ml, and 8.39±4.804d in the OLIF group and 198.75±23.27min, 65.00±44.62ml, and 8.75±2.30d in the CLIF group, with no statistical difference between the two groups(P>0.05). In the OLIF group, 5 patients developed numbness in the anterior thigh and hip flexion weakness after surgery, which recovered after 1 month of nerve nutrition treatment; 1 case of incisional infection was cured after 3 weeks of anti-infection treatment. 4 cases in the CLIF group developed numbness in the anterior thigh and hip flexion weakness, which recovered after 1 month of nerve nutrition treatment; 1 patient developed intraoperative lumbar segmental artery injury, with bleeding volume reaching 200ml; 1 patient had psoas major muscle effusion with infection, cured after 6 weeks of antibiotic treatment. There were no significant differences in VAS, ODI, LL and DH between the two groups before surgery(P>0.05), significant improvements at 1 month, 6 months and 1 year after surgery compared with those before surgery(P<0.05), and no significant differences between groups at the same time point after surgery(P>0.05). The differences between 1 month postoperatively and 1 year postoperatively between OLIF and CLIF groups(12.47°±6.69° vs 6.26°±6.47°) were with statistical significance(P<0.05). At the 1-year postoperative follow-up, there was no statistical difference in the intervertebral fusion rate(83.33% vs 91.67%) and cage subsidence height(1.54±0.72mm vs 1.44±0.61mm) between the OLIF and CLIF groups. The angle between cage and coronal plane was significantly greater in the OLIF group(8.94°±4.97°) than that in the CLIF group(5.30°±3.69°)(P<0.05). Conclusions: Both OLIF and CLIF combined with posterior percutaneous pedicle screw fixation can achieve satisfactory short-term clinical results and comparable efficacy in degenerative lumbar instability, while CLIF has some advantages in increasing LL and maintaining lumbar curvature using a multi-angle fusion.