Safety and early clinical efficacy of oblique lateral interbody fusion combined with lateral integrated plate fixation in the treatment of lumbar degenerative diseases

English Keywords:Lumbar degenerative diseases  Lateral fixation  Pedicle screw  Interbody fusion  Complication

English Abstract:

  【Abstract】 Objectives: To summarize the early results, clinical advantages and safety of oblique lateral interbody fusion(OLIF) combined with lateral integrated plate fixation in the treatment of single-segment lumbar degenerative diseases by comparing with OLIF combined with posterior pedicle screw fixation. Methods: A retrospective analysis was made on 46 cases(14 males and 32 females) admitted to our hospital since June 2019. The age ranged from 30 to 69 years, with an average of 59.98±6.86 years; Disease types: 18 cases of lumbar disc degeneration, 10 cases of lumbar spinal stenosis, and 18 cases of lumbar degenerative spondylolisthesis; The lesions were located in L3/4 of 13 cases, and L4/5 of 33 cases; Bone mineral density(BMD): T>-1.0SD in 34 cases, -2.5SD＜T≤-1.0SD in 12 cases; BMI: 16-24kg/m2, averaged 22.40±1.95(kg/m)2. 21 cases were treated with OLIF combined with lateral integrated plate fixation(as the integrated fixation group), and the other 25 cases were treated with OLIF combined with posterior pedicle screw fixation(as the combined fixation group). The imaging data, clinical results, and complications of the two surgical methods were observed and compared. Results: The operative time and intraoperative bleeding in the integrated fixation group(49.33±3.94min, 38.70±12.76mL) were significantly shorter than or less than that in the combined fixation group(97.40±8.25min, 84.60±20.13mL), with a statistical difference(P＜0.001). Both groups of patients were followed up for 24 to 36 months, with an average of 28.29±4.70 months. During the follow-up, there was no loosening and breakage of implant, or cage displacement. Classification of cage subsidence: there were 18 cases of grade 0 and 3 cases of grade I in the integrated fixation group, and 25 cases of grade 0 and 0 case of grade I in the combined fixation group, and the difference was statistically significant(P＝0.036). The height of intervertebral space in the two groups recovered significantly after operation, and there were varied degrees of losses in both groups during follow-up. At the final follow-up, the intervertebral height loss in the integrated fixation group was greater than that in the combined fixation group, and the difference was statistically significant(P＝0.046). At the final follow-up, the balance of coronal and sagittal planes of the lumbar vertebrae in the two groups were both recovered well, and there was no statistical difference between groups(P＝0.139, P＝0.149). Both groups achieved good fusion with a fusion rate of 100%. Although the lumbar pain and lumbar function of the two groups recovered significantly at the final follow-up, the integrated fixation group was better than the combined fixation group at three months after operation. During the follow-up, there was no loosening and breakage of implant, or cage displacement. Complications: the incidence rate of the integrated fixation group was 4.76%, and that of the combined fixation group was 8.0%, with no statistical difference(P＝0.082). Conclusions: Under the premise of strict case selection, OLIF combined with integrated plate fixation for the treatment of single-segment lumbar diseases has good early clinical results and is safety, which is obviously superior in the operative time, intraoperative bleeding, and early recovery than OLIF combined with posterior pedicle screw fixation, yet it is recommended to use with caution for the strength of integrated fixation in improving the stability of OLIF fusion segment is limited, the cage subsidence rate is high, and the ability to maintain intervertebral height is poor.