Comparison Of Short-term Clinical Efficacy Between OLIF And MIS-TLIF In Treatment Of Degenerative Lumbar

Objective: To compare the short-term radiographic and clinical outcomes of oblique lumbar interbody fusion(OLIF)and minimally invasive lumbar interbody fusion(MIS-TLIF)for the treatment of low-grade degenerative lumbar spondylolisthesis at L4/5.Methods: Patients who diagnosed with DLS at the 900 th Hospital of the Joint Logistics Support Force from September 2017 to February 2019 were retrospectively analyzed in this study.According to the inclusion and exclusion criteria,53 patients with L4/5low-grade degenerative lumbar spondylolisthesis were selected as the research target.Patients included were divided into the OLIF group(n=24)and the MIS-TLIF group(n=29)according to the different surgeries they underwent.The operation time,intraoperative blood loss,postoperative length of hospital stay and complications of the two groups were observed;According to the imaging data,the disc height(DH),foraminal height(FH),lumbar lordosis angle(LL),segmental lordosis angle(SL),vertebral slip index(SI),L1 axis S1 distance(LASD)of the two groups were compered preoperatively at 1 week,3 months,and 12 months postoperatively.Intervertebral fusion was evaluated according to lumbar X-ray at 3 and 12 months postoperatively.The Visual analogue scale(VAS)and Oswestry dysfunction index(ODI)were compared preoperatively at 1 week,3 months,and 12 months postoperatively.Result: 53 patients were followed up for 12 months.The intraoperative blood loss(81.6±17.0)ml were significantly lower in OLIF group than in MIS-TLIF group(92.7±15.8)ml(P<0.05).However,there was no significant difference between two group in the operation time and postoperative length of hospital stay(P>0.05).At 1week,3 months,and 12 months postoperatively,the DH,FH,LL,SL,SI and LASD were significantly improved in the same group(P<0.05).The DH,FH,SL and LASD of OLIF group were significantly superior than those of MIS-TLIF group(P<0.05).However,there was no significant difference between two group in the LL postoperatively(P>0.05).There were no significant differences in VAS and ODI preoperatively(P>0.05).The VAS and ODI were significantly improved postoperatively(P<0.05),and the VAS of back in OLIF group(2.2±0.6)were lower than those of MIS-TLIF group(2.6±0.6)at 1 week postoperatively(P<0.05).There was no significant difference between the two groups at 3 and 12 months postoperatively(P>0.05).The intervertebral fusion in OLIF group(70.8%)were significantly better than those of MIS-TLIF group(41.4%)at 3 months postoperatively(P<0.05).However the intervertebral fusion was 95.8% in the OLIF group and 93.1% in the MIS-TLIF group at 12 months postoperatively,there was no significant difference(P>0.05).Complications: 1 patient had sympathetic nerve injury in OLIF group,which showed the change of left thigh pain and temperature.1 patient had weakness of hip flexion.All recovered within 3 weeks postoperatively.One case of nerve root injury occurred in MIS-TLIF group.The subsidence rate was 4.2% in the OLIF group and 6.9% in the MIS-TLIF group.There was no significant difference between the two groups at 12 months postoperatively(P>0.05).Conclusion: OLIF and MIS-TLIF can improve the clinical symptoms in the treatment of low-grade degenerative lumbar spondylolisthesis at L4/5.OLIF shows less blood loss,earlier time to fusion,reduce short-term lumbago postoperatively and effectively restore the balance of lumbar sagittal plane.So OLIF may be considered as an acceptable surgical option for the treatment of l4/5 low-grade degenerative lumbar spondylolisthesis.