The early efficacy analysis of oblique lateral interbody fusion combined with different fixation for the treatment of lumbar degenerative spondylolisthesis

English Keywords:Lumbar spondylolisthesis  Oblique lateral interbody fusion  Lateral plate  Pedicle screw

English Abstract:

  【Abstract】 Objectives: The purpose of this study was to compare the clinical efficacies and complications of oblique lateral interbody fusion(OLIF) combined with two different fixations for the treatment of lumbar degenerative spondylolisthesis(LDS). Methods: 53 patients with LDS who underwent OLIF between January 2020 and January 2022 were retrospectively analyzed, including 24 males and 29 females, with an average age of 62.17±9.72 years. Among the patients, 24 were treated with OLIF combined with lateral plate(LP)(the LP group) and 29 were treated with OLIF combined with pedicle screw(PS)(the PS group). There were no significant differences in age, gender, body mass index(BMI) and other population characteristics between the two groups. The operative time, blood loss, and the complications were recorded. Before operation, at postoperative 7d, 3 and 12 months, the visual analog scale(VAS) score, Oswestry disability index(ODI), and the imaging parameters such as disc height(DH), foraminal height(FH) and cross-sectional area(CSA) were also evaluated. At final follow-up, the rate of intervertebral fusion was assessed according to the Bridwell assessment system. Results: The patients were followed up for 13.2±6.5(range 12-16) months. LP group was less than PS group in operative time and blood loss(75.41±11.53min vs 127.05±5.62min, P<0.05; 39.55±5.32mL vs 89.81±9.62mL, P<0.05). There were no significant differences in preoperative VAS score and ODI between the two groups. One week after surgery, both VAS and ODI in LP group improved much better than those of PS group[3.05±0.67 vs 4.55±0.39, P<0.01; (17.36±2.76)% vs (22.80±6.02)%, P<0.01]. However, the difference disappeared at 1 year of follow-up. In LP group, the DH, FH and CSA were 8.96±1.23mm, 16.18±3.49mm and 88.95±14.79mm2 respectively before operation, which were significantly improved to 12.53±3.47mm, 20.14±3.12mm, 124.83±7.56mm2 one year after surgery, respectively. Also, the preoperative DH, FH and CSA were 8.66±2.21mm, 16.35±5.19mm, and 89.23±12.18mm2 respectively in PS group, and 12.32±4.67mm, 20.86±3.44mm, 125.75±7.76mm2 one year after surgery, which were also significantly improved than before. However, there was no difference between groups at the same time points. The intervertebral fusion was achieved in 22 cases(91.6%) in LP group, which was slightly lower than that in the PS group(93.10%) without statistical significance. In LP group, two patients experienced cage subsidence and two patients occurred lumbosacral plexus injury, while two patients experienced cage subsidence and only one patient occurred lumbosacral plexus injury in PS group. There was no significant difference between the two groups(P>0.05). Conclusions: Both OLIF+LP and OLIF+PS are effective method for the treatment of lumbar spondylolisthesis. Comparing with OLIF+PS, OLIF+LP has comparable clinical effect, less blood loss and shorter operative time.