Sahoo Auroshish, Jain Mantu, Naik Suprava, Das Gurudip, Kumar Pankaj, Tripathy Sujit Kumar, Ratna Harish V K, Ramasubbu Mathan Kumar
Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.
Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.
J Neurosci Rural Pract. 2024 Jan-Mar;15(1):53-61. doi: 10.25259/JNRP_322_2023. Epub 2023 Oct 27.
Open transforaminal lumbar interbody fusion (O-TLIF) remains the most popular and widely practiced lumbar fusion method even today, providing direct decompression. Oblique lateral interbody fusion (OLIF) is a novel retroperitoneal approach that allows placement of a large interbody cage which provides an indirect neural decompression, and screws can be placed minimal invasively or through the Wiltse OLIF (W-OLIF) approach. We aim to find out the short-term efficacy of W-OLIF to O-TLIF in terms of radiological and clinical outcomes in patients of lumbar degenerative diseases.
Fifty-two patients were divided equally into two groups (group O-TLIF and group W-OLIF). Several parameters were measured, such as the spinal cord cross-sectional area (SC-CSA), foraminal cross-sectional area (F-CSA), disc height (DH), foraminal height (FH), Schizas grade for stenosis, and Meyerding's grading for olisthesis. Functional scores were measured using the visual analog scale (VAS) for low back pain (LBP) and lower limbs, Oswestry Disability Index. All parameters were repeat measured at 3 months follow-up. Statistical analysis was done using SPSS software.
Both groups were similar in composition preoperatively. There was significant improvement in all clinical and radiological parameters post-surgery in either group. However, at 3 months, The DH, FH, FSA, and VAS (LBP) were better in the W-OLIF group than in O-TLIF. Procedure-related complications were seen in both groups (15% in the O-TLIF group and 19% in the W-TLIF group), but only one patient in O-TLIF required revision due to cage migration.
Similar improvement occurs in most of the clinical and radiological parameters in the W-OLIF group compared to the O-TLIF group. Few radiological parameters such as the DH, FH, and F-CSA and the VAS (LBP) correction are superior in the W-OLIF group in the short-term follow-up. We conclude that indirect decompression by W-OLIF provides equivalent, if not better, results than the traditional O-TLIF lumbar fusion.
即使在今天，开放式经椎间孔腰椎椎间融合术（O-TLIF）仍然是最流行且应用最广泛的腰椎融合方法，可提供直接减压。斜外侧椎间融合术（OLIF）是一种新型的腹膜后入路，可置入大型椎间融合器，提供间接神经减压，并且可以通过微创方式或经威尔茨氏OLIF（W-OLIF）入路置入螺钉。我们旨在探讨在腰椎退行性疾病患者中，W-OLIF与O-TLIF相比在放射学和临床结果方面的短期疗效。
52例患者平均分为两组（O-TLIF组和W-OLIF组）。测量了多个参数，如脊髓横截面积（SC-CSA）、椎间孔横截面积（F-CSA）、椎间盘高度（DH）、椎间孔高度（FH）、狭窄的Schizas分级以及椎体滑脱的迈耶丁分级。使用视觉模拟量表（VAS）测量下腰痛（LBP）和下肢的功能评分以及奥斯维斯特里功能障碍指数。所有参数在术后3个月随访时重复测量。使用SPSS软件进行统计分析。
两组术前组成相似。两组术后所有临床和放射学参数均有显著改善。然而，在术后3个月时，W-OLIF组的DH、FH、FSA和VAS（LBP）均优于O-TLIF组。两组均出现了与手术相关的并发症（O-TLIF组为15%，W-TLIF组为19%），但O-TLIF组中只有1例患者因椎间融合器移位需要翻修。
与O-TLIF组相比，W-OLIF组在大多数临床和放射学参数上有相似的改善。在短期随访中，W-OLIF组在一些放射学参数如DH、FH和F-CSA以及VAS（LBP）改善方面更优。我们得出结论，W-OLIF间接减压提供的结果即使不比传统的O-TLIF腰椎融合术更好，也与之相当。
