Wang Weiheng, Xiao Bing, Wang Haotian, Qi Junqiang, Gu Xin, Yu Jiangming, Ye Xiaojian, Xu Guohua, Xi Yanhai
Department of Orthopaedics, Second Affiliated Hospital of Naval Medical University, Shanghai, China.
Department of Orthopedics, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Front Surg. 2022 Oct 6;9:1013431. doi: 10.3389/fsurg.2022.1013431. eCollection 2022.
Oblique lateral interbody fusion (OLIF) has unique advantages in the treatment of discogenic low back pain (DBP). However, there are few studies in this area, and no established standard for additional posterior internal fixation. The purpose of this study was to investigate the efficacy of OLIF stand-alone vs. combined with percutaneous pedicle screw fixation (PPSF) in the treatment of DBP.
This retrospective case-control study included forty patients. All patients were diagnosed with DBP by discography and discoblock. Perioperative parameters (surgery duration, blood loss, and muscle damage), complications, Visual analog scale (VAS), and Oswestry Disability Index (ODI) were assessed. Imaging data including cage subsidence, cage retropulsion, fusion rate, and adjacent spondylosis degeneration (ASD) were analyzed.
There were 23 patients in the OLIF stand-alone group and 17 patients in the OLIF + PPSF group. The mean surgery duration, blood loss, and muscle damage in the OLIF stand-alone group were significantly better than those in the OLIF + PPSF group ( < 0.05). However, there was no significant difference in the average hospitalization time between the two groups ( > 0.05). There was no significant difference in the VAS and ODI scores between the two groups before surgery ( > 0.05), and VAS and ODI scores significantly improved after surgery ( < 0.05). The VAS and ODI scores in the OLIF stand-alone group were significantly better than those in the OLIF + PPSF group at 1 month ( < 0.05), While there was no significant difference between the two groups at 12 months and last follow up ( > 0.05). At the last follow-up, there was no significant difference in cage subsidence, fusion rate, ASD and complication rate between the two groups ( > 0.05).
OLIF stand-alone and OLIF + PPSF are both safe and effective in the treatment of DBP, and there is no significant difference in the long-term clinical and radiological outcomes. OLIF stand-alone has the advantages of surgery duration, blood loss, muscle damage, and early clinical effect. More clinical data are needed to confirm the effect of OLIF stand-alone on cage subsidence and ASD. This study provides a basis for the clinical application of standard DBP treatment with OLIF.
斜外侧椎间融合术（OLIF）在治疗椎间盘源性下腰痛（DBP）方面具有独特优势。然而，该领域的研究较少，且对于额外的后路内固定尚无既定标准。本研究的目的是探讨单纯OLIF与联合经皮椎弓根螺钉固定（PPSF）治疗DBP的疗效。
这项回顾性病例对照研究纳入了40例患者。所有患者均经椎间盘造影和椎间盘阻滞诊断为DBP。评估围手术期参数（手术时间、失血量和肌肉损伤）、并发症、视觉模拟评分（VAS）和Oswestry功能障碍指数（ODI）。分析影像学数据，包括椎间融合器下沉、椎间融合器后凸、融合率和相邻节段退变（ASD）。
单纯OLIF组有23例患者，OLIF + PPSF组有17例患者。单纯OLIF组的平均手术时间、失血量和肌肉损伤均显著优于OLIF + PPSF组（P < 0.05）。然而，两组的平均住院时间无显著差异（P > 0.05）。两组术前VAS和ODI评分无显著差异（P > 0.05），术后VAS和ODI评分显著改善（P < 0.05）。单纯OLIF组在术后1个月时的VAS和ODI评分显著优于OLIF + PPSF组（P < 0.05），而在术后12个月及末次随访时两组无显著差异（P > 0.05）。在末次随访时，两组在椎间融合器下沉、融合率、ASD和并发症发生率方面无显著差异（P > 0.05）。
单纯OLIF和OLIF + PPSF治疗DBP均安全有效，长期临床和影像学结果无显著差异。单纯OLIF在手术时间、失血量、肌肉损伤和早期临床效果方面具有优势。需要更多临床数据来证实单纯OLIF对椎间融合器下沉和ASD的影响。本研究为OLIF标准化治疗DBP的临床应用提供了依据。
