Comparative study of the efficacy of lateral lumbar interbody fusion combined with anterolateral screw fixation or bilateral pedicle screw fixation in the treatment of lumbar degenerative diseases

English Keywords:Lateral lumbar interbody fusion  Lumbar degenerative disease  Pedicle screws  Internal fixation

English Abstract:

  【Abstract】 Objectives: To compare the efficacy and imaging parameters of lateral lumbar interbody fusion(LLIF) combined with anterolateral screw fixation(AF) or bilateral pedicle screw fixation(BPSF) in the treatment of lumbar degenerative disease(LDD). Methods: A retrospective study was conducted on 100 patients with single-segment LDD who underwent LLIF-AF or LLIF-BPSF treatment at the First Affiliated Hospital of Kunming Medical University between December 2019 and December 2021. The patients were divided into the AF group(50 cases) and the BPSF group(50 cases). There was no statistical difference in the general information such as gender, age, and body mass index(BMI) between the two groups(P>0.05). The perioperative data(length of hospital stay, operative time, intraoperative blood loss); Pre-operative, postoperative 7d, postoperative 6 months′ visual analog scale(VAS) scores for low back and leg pain, Oswestry disablity index(ODI), imaging parameters such as disc height(DH), foraminal height(FH), cross-sectional area(CSA), as well as surgical complications were collected and analyzed, and the risk factors for intervertebral subsidence and non-fusion of fusion device were explored. Results: AF group was better than BPSF group in operative time, intraoperative blood loss, and hospital stay[125.0±26.6min vs 221.6±52.2min, 25.0mL(20.0-50.0mL) vs 100.0mL(90.0-150.0mL)，12.5±4.8d vs 14.9±4.6d], and the differences were statistically significant(P<0.05). For the low back and leg pain VAS scores and ODI, as well as DH, FH, and CSA, the postoperative 7d and 6 months′ values were signiticantly improved than before operation in both groups(P<0.05), while no statistically significant differences were found between groups at the same time points(P>0.05). Intervertebral subsidence occurred in 12 patients in each group, and there was no statistically significant difference between the two groups. There were statistically significant differences in BMI and QCT between the AF and BPSF groups of patients with subsidence of the intervertebral space and those without subsidence at 6 months after operation; There were statistically significant differences in QCT between the two groups of patients with non-fusion and fusion of the fusion device; BMI≥28kg/m2 and QCT＜80mg/cm3 were the independent risk factors for intervertebral subsidence in AF group, but not in the BPSF group; QCT＜80mg/cm3 was the independent risk facors for non-fusion of fusion device in both AF and BPSF groups. Conclusions: LLIF combined with AF or BPSF are both reliable methods for treating LDD. For patients with a high body weight of BMI≥28kg/m2 or decreased bone density of QCT＜80mg/cm3, BPSF internal fixation can provide stronger mechanical stability to the spine, reducing the incidence of postoperative disc space collapse or fusion device non-union; On the contrary, AF internal fixation has shorter operative time and hospital stay, less intraoperative blood loss, which can be considered as a priority.