Effect of bone mineral density on the clinical efficacy of oblique lateral interbody fusion in the treatment of lumbar degenerative spondylolisthesis

English Keywords:Lumbar degenerative spondylolisthesis  Bone mineral density  Oblique lumbar interbody fusion  Fusion rate  Clinical efficacy  Intervertebral disc height

English Abstract:

  【Abstract】 Objectives: To analyze the clinical effect of bone mineral density(BMD) on the efficacy of oblique lateral interbody fusion(OLIF) in the treatment of lumbar degenerative spondylolisthesis(LDS). Methods: A retrospective analysis was conducted on the clinical data of patients with Meyerding grade Ⅰ LDS who underwent OLIF assisted with a minimally invasive spinal channel system between December 2017 and July 2020. Based on the preoperative BMD, the patients were divided into low bone mass group(-2.50.05). The operative time, intraoperative blood loss, ambulation time after surgery, length of hospital stay, and complications were collected and compared between the two groups. The postoperative 1 week reduction rate of spondylolisthesis, and postoperative 1 month improvement in spinal canal cross-sectional area, and intervertebral disc height restoration were counted and compared; Bone graft fusion was observed of the two groups of patients on X-ray images at 3 months, 6 months, and 12 months of follow-up after operation. The Japanese Orthopaedic Association(JOA) scores were assessed at pre-operation, and 1, 3, 6 and 12 months after operation, and JOA score at 12 months after operation was used to determine the improvement rate of JOA score. Results: Comparing with the osteoporosis group, the low bone mass group was shorter in operative time(119.5±12.7min vs. 163.3±14.2min), less in intraoperative blood loss(98.9±22.4mL vs. 211.5±29.8mL), shorter in ambulation time after surgery(2.3±0.9d vs. 3.9±1.2d) and length of hospital stay(6.2±1.3d vs. 8.9±1.6d)(P<0.05). At 1 week postoperatively, complete reduction was observed in 29 cases(96.7%) in the low bone mass group and 15 cases(68.2%) in the osteoporosis group. There was a statistically significant difference in the reduction outcomes between the two groups(P<0.05). After OLIF treatment, statistically significant differences were noted between the postoperative dural sac cross-sectional area and the intervertebral disc height and the preoperative values, respectively(P<0.05). The recovery of intervertebral disc height of the osteoporosis group was significant different from that of the low bone mass group (12.79±0.99mm vs. 11.25±0.98mm, P<0.05), while the improvement of the dural sac cross-sectional area was not(P>0.05). The fusion rates were not significantly different between the two groups(93.3% vs 77.3%, P>0.05). The JOA scores at 1 month and 3 months after surgery in the low bone mass group were statistically significant different from those of the osteoporosis group(P<0.05), while the JOA scores at 6 and 12 months after surgery were not significantly different between the two groups(P>0.05). Conclusions: OLIF can achieve satisfactory short-term clinical outcomes in low bone mass and osteoporosis LDS patients, and its efficacy is better in patients with low bone mass than patients with osteoporosis.