Department of Spine Surgery, Beijing Jishuitan Hospital, No.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China.
Department of Spine Surgery, Shanghai Changzheng Hospital, No.415, Fengyang road, Huangpu District, Shanghai, 200003, China.
BMC Musculoskelet Disord. 2020 Mar 23;21(1):184. doi: 10.1186/s12891-020-03192-7.
To compare standalone oblique lateral interbody fusion (OLIF) vs. OLIF combined with posterior bilateral percutaneous pedicle screw fixation (OLIF combined) for the treatment of lumbar spondylolisthesis.
This was a retrospective study of patients who underwent standalone OLIF or combined OLIF between 07/2014 and 08/2017 at two hospitals in China. Direct decompressions were not performed. Visual analog scale (VAS), Oswestry Disability Index (ODI), satisfaction rate, anterior/posterior disc heights (DH), foraminal height (FH), foraminal width (FW), cage subsidence, cage retropulsion, fusion rate, and complications were analyzed. All imaging examinations were read independently by two physicians and the mean measurements were used for analysis.
A total of 73 patients were included: 32 with standalone OLIF and 41 with combined OLIF. The total complication rate was 25.0% with standalone OLIF and 26.8% with combined OLIF. There were no differences in VAS and ODI scores by 2 years of follow-up, but the scores were better with standalone OLIF at 1 week and 3 months (P < 0.05). PDH and FW was smaller in the combined OLIF group compared with the standalone OLIF group before and after surgery (all P < 0.05). There were significant differences in FH before surgery and at 1 week and 3 months between the two groups (all P < 0.05), but the difference disappeared by 2 years (P = 0.111). Cage subsidence occurred in 7.3% (3/41) and 7.3% (3/41) of the patients at 3 and 24 months, respectively, in the combined OLIF group, compared with 6.3% (2/32) and 15.6% (5/32), respectively, in the standalone OLIF group at the same time points (P = 0.287). There was no cage retropulsion in both groups at 2 years. The fusion rate was 85.4%(35/41) in the combined OLIF group and 84.4% (27/32) in the standalone OLIF group at 3 months(P = 0.669). At 24 months, the fusion rate was 100.0% in the combined OLIF group and 93.8% (30/32) in the standalone OLIF group (P = 0.066).
Standalone OLIF may achieve equivalent clinical and radiological outcomes than OLIF combined with fixation for spondylolisthesis. The rate of complications was similar between the two groups. Patients who are osteoporotic might be better undergoing combined rather than standalone OLIF. The possibilty of proof lies within a future prospective study, preferably an RCT.
比较单纯侧方椎间融合术（OLIF）与 OLIF 联合后路双侧经皮椎弓根螺钉固定术（OLIF 联合）治疗腰椎滑脱症的疗效。
这是一项回顾性研究，纳入了 2014 年 7 月至 2017 年 8 月在中国两家医院接受单纯 OLIF 或 OLIF 联合治疗的患者。未行直接减压。分析视觉模拟评分（VAS）、Oswestry 功能障碍指数（ODI）、满意度、前/后椎间盘高度（DH）、椎间孔高度（FH）、椎间孔宽度（FW）、 cage 下沉、 cage 后移、融合率和并发症。所有影像学检查均由两名医生独立阅读，采用平均值进行分析。
共纳入 73 例患者：单纯 OLIF 组 32 例，OLIF 联合组 41 例。单纯 OLIF 组总并发症发生率为 25.0%，OLIF 联合组为 26.8%。随访 2 年时，VAS 和 ODI 评分无差异，但单纯 OLIF 组在 1 周和 3 个月时评分更好（P<0.05）。OLIF 联合组术后 PDH 和 FW 均小于单纯 OLIF 组（均 P<0.05）。两组患者术前及术后 1 周和 3 个月 FH 均有显著差异（均 P<0.05），但随访 2 年时差异消失（P=0.111）。OLIF 联合组 cage 下沉分别发生在术后 3 个月和 24 个月时的 7.3%（3/41）和 7.3%（3/41），单纯 OLIF 组 cage 下沉分别发生在术后 3 个月和 24 个月时的 6.3%（2/32）和 15.6%（5/32），两组间差异无统计学意义（P=0.287）。两组均未发生 cage 后移。OLIF 联合组术后 3 个月融合率为 85.4%（35/41），单纯 OLIF 组为 84.4%（27/32）（P=0.669）。随访 24 个月时，OLIF 联合组融合率为 100.0%（41/41），单纯 OLIF 组为 93.8%（32/32）（P=0.066）。
单纯 OLIF 与 OLIF 联合固定治疗腰椎滑脱症的临床和影像学效果相当。两组并发症发生率相似。骨质疏松患者可能更适合行 OLIF 联合固定术。这有待于未来前瞻性研究，特别是 RCT 进一步证实。
