Department of Orthopaedic Surgery, Kansai Medical University Medical Center, Moriguchi, Osaka 570-8507, Japan.
Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo Japan.
J Orthop Sci. 2021 Nov;26(6):992-998. doi: 10.1016/j.jos.2020.10.013. Epub 2020 Dec 16.
The lateral interbody fusion (LIF) has gained popularity for the surgical treatment of lumbar degenerative spondylolisthesis (DS), however, LIF often requires the position change for posterior screwing. We have performed the single-position lateral surgery of oblique lateral interbody fusion (OLIF) and posterior screwing (OLIF-LPF). The present study compared the clinical and radiologic results between OLIF-LPF and minimally invasive transforaminal interbody fusion (MIS-TLIF).
A total of 142 patients underwent either OLIF-LPF (92 cases) or MIS-TLIF (50 cases) for L3 or L4 DS. The average age was 72 and 70 years old, respectively. The OLIF-LPF was performed in right decubitus position with allograft and percutaneous modified cortical bone trajectory screws (mCBT). The MIS-TLIF utilized a single 4 cm midline incision, allograft, boomerang cage and mCBTs. The operation time, estimated blood loss, and serum CRP levels were recorded. JOABPEQ effectiveness rate (%), Visual Analogue Scale (VAS), fusion rate, segmental radiologic alignment, and complications were also evaluated.
Average follow-up period was 31 and 57 months in OLIF-LPF and MIS-TLIF, respectively. The average operation time and estimated blood loss were 108min, 51 ml and 104 min and 69 ml, respectively. OLIF-LPF demonstrated significantly higher values of mental health domain of JOABPEQ effectiveness rate and VAS improvement of leg pain than those in MIS-TLIF. The less correction loss of posterior disc height was demonstrated in OLIF-LPF. The fusion rate and symptomatic adjacent segment degeneration (ASD) were statistically equivalent between two groups.
The single-position surgery of OLIF combined with posterior screwing serves as a safe, minimally invasive and effective surgical modality without the need of position change. It provides comparable fusion rate, segmental radiologic alignment, and symptomatic adjacent segment degeneration to MIS-TLIF surgery.
外侧椎间融合术（LIF）在腰椎退行性滑脱（DS）的手术治疗中越来越受欢迎，然而，LIF 通常需要改变位置进行后路螺钉固定。我们已经进行了单体位斜外侧椎间融合术（OLIF）和后路螺钉固定（OLIF-LPF）的单次手术。本研究比较了 OLIF-LPF 和微创经椎间孔椎间融合术（MIS-TLIF）的临床和影像学结果。
共 142 例 L3 或 L4 DS 患者分别接受 OLIF-LPF（92 例）或 MIS-TLIF（50 例）治疗。平均年龄分别为 72 岁和 70 岁。OLIF-LPF 在右侧卧位下进行，使用同种异体骨和经皮改良皮质骨轨迹螺钉（mCBT）。MIS-TLIF 采用单一 4cm 中线切口、同种异体骨、Boomerang 椎间融合器和 mCBTs。记录手术时间、估计失血量和血清 CRP 水平。还评估了 JOABPEQ 有效率（%）、视觉模拟量表（VAS）、融合率、节段影像学排列和并发症。
OLIF-LPF 和 MIS-TLIF 的平均随访时间分别为 31 个月和 57 个月。平均手术时间和估计失血量分别为 108 分钟和 51ml，104 分钟和 69ml。OLIF-LPF 在心理健康领域的 JOABPEQ 有效率和腿部疼痛 VAS 改善方面明显高于 MIS-TLIF。OLIF-LPF 显示后椎间盘高度的矫正丢失较少。两组的融合率和症状性邻近节段退变（ASD）无统计学差异。
OLIF 联合后路螺钉的单体位手术是一种安全、微创、有效的手术方式，无需改变体位。它提供了与 MIS-TLIF 手术相当的融合率、节段影像学排列和症状性邻近节段退变。
