Liu Fengyu, Sun Xianze, Meng Xianzhong
Department of Spine Surgery, Hebei Medical University Third Hospital, NO.139 Ziqiang Road, Shijiazhuang, 050000, China.
Department of Spine Surgery, The Third Hospital of Shijiazhuang, Shijiazhuang, 050000, China.
BMC Musculoskelet Disord. 2025 Apr 29;26(1):424. doi: 10.1186/s12891-025-08675-z.
The use of oblique lumbar interbody fusion (OLIF) to treat severe central lumbar spinal stenosis remains contentious. This study sought to assess the efficacy of OLIF without posterior decompression in the treatment of severe central lumbar spinal stenosis.
Between October 2018 and October 2022, 48 patients who underwent OLIF were retrospectively analyzed. All patients had a preoperative magnetic resonance imaging diagnostic of severe central lumbar spinal stenosis according to the Schizas classification (grade C or D). All patients complained of low back and leg pain, which presented with intermittent claudication or dynamic radicular pain. The symptoms were mostly relieved in supine position. Clinical and radiological outcomes were evaluated.
Seven patients received stand-alone OLIF. Eight patients were treated with OLIF, and percutaneous transpedicular screw fixation was performed within one week after OLIF. Thirty-three patients underwent a single-stage OLIF with percutaneous pedicle screw fixation. All patients' clinical outcomes improved significantly over time, including ODI (63.1 ± 12.2/17.5 ± 5.8/7.8 ± 4.5/6.9 ± 4.6, p < 0.01), VAS of low back pain (6.1 ± 1.7/2.4 ± 1.0/1.1 ± 0.8/1.0 ± 0.7, p < 0.01), and VAS of leg pain (5.8 ± 1.5/1.9 ± 0.9/0.9 ± 0.8/0.8 ± 0.7, p < 0.05) recorded preoperatively and 1, 3, and 12 months postoperatively. The mean disc height increased from 7.8 ± 2.1 mm preoperatively to 10.4 ± 1.7 mm one week postoperatively (p < 0.01) and dropped to 10.1 ± 1.8 mm 12 months postoperatively (p < 0.01). The segmental lordosis angle increased from 7.7 ± 3.3 preoperatively to 8.9 ± 3.2 at one week postoperatively (p < 0.01) and remained stable at 12 months (8.8 ± 3.3, p = 0.22). The CSA increased considerably over time, from 44.0 ± 18.6 mm2 preoperatively to 65.1 ± 20.8 mm2 (p < 0.01) at one week postoperatively and 124.9 ± 19.2 mm2 at 12 months postoperatively (p < 0.01). Two patients with stand-alone OLIF underwent decompression surgery due to postoperative cage subsidence and recurrence of lower extremity problems. At one year of follow-up, the fusion rate was 97.9%.
OLIF combined with pedicle screw fixation is effective in treating severe central lumbar spinal stenosis. It is a good option for patients whose symptoms can be relieved in supine position.
采用斜外侧腰椎椎间融合术（OLIF）治疗重度中央型腰椎管狭窄症仍存在争议。本研究旨在评估不进行后路减压的OLIF治疗重度中央型腰椎管狭窄症的疗效。
回顾性分析2018年10月至2022年10月期间接受OLIF手术的48例患者。所有患者术前磁共振成像检查均根据Schizas分类（C级或D级）诊断为重度中央型腰椎管狭窄症。所有患者均主诉腰腿痛，表现为间歇性跛行或动态神经根性疼痛。症状大多在仰卧位时缓解。评估临床和影像学结果。
7例患者接受单纯OLIF手术。8例患者接受OLIF手术，并在OLIF术后1周内进行经皮椎弓根螺钉内固定。33例患者接受一期OLIF联合经皮椎弓根螺钉内固定。所有患者的临床结果随时间均有显著改善，包括术前及术后1、3和12个月记录的腰椎功能障碍指数（ODI）（63.1±12.2/17.5±5.8/7.8±4.5/6.9±4.6，p<0.01）、腰背痛视觉模拟评分（VAS）（6.1±1.7/2.4±1.0/1.1±0.8/1.0±0.7，p<0.01）和腿痛VAS（5.8±1.5/1.9±0.9/0.9±0.8/0.8±0.7，p<0.05）。平均椎间盘高度从术前的7.8±2.1mm增加到术后1周的10.4±1.7mm（p<0.01），术后12个月降至10.1±1.8mm（p<0.01）。节段性前凸角从术前的7.7±3.3增加到术后1周的8.9±3.2（p<0.01），术后12个月保持稳定（8.8±3.3，p=0.22）。椎管面积随时间显著增加，从术前的44.0±18.6mm²增加到术后1周的65.1±20.8mm²（p<0.01），术后12个月为124.9±19.2mm²（p<0.01）。2例单纯OLIF手术患者因术后椎间融合器下沉及下肢问题复发而接受减压手术。随访1年时，融合率为97.9%。
OLIF联合椎弓根螺钉内固定治疗重度中央型腰椎管狭窄症有效。对于症状在仰卧位可缓解的患者是一个不错的选择。
