The Comparison And Analysis About The Clinical Efficacy Of OLIF And PLIF、TLIF In The Treatment Of Lumbar Degenerative Diseases

BackgroundLumbar degenerative disease(LDD)is a common disease in spine surgery,which often occurs in middle-aged and elderly groups,leading to a decline in patients’ quality of life.If conservative treatment is not effective,the symptoms can only be improved by surgery.Through continuous application and innovation,interbody fusion(LIF)has become a common method in the treatment of various lumbar degenerative diseases.Oblique lateral interbody fusion(OLIF)has the advantages of less trauma,faster recovery and significant early curative effect compared with traditional surgery.It has been widely applied in recent years,but whether there is any difference in long-term curative effect between OLIF and traditional surgery needs to be further explored.ObjectiveThis study of the first people’s hospital in Yunnan province using three different approach lumbar intervertebral fusion(PLIF,TLIF,OLIF)treatment of lumbar degenerative disease of the patients with follow-up observation,statistic operation time,blood loss,hospital stay,and each review stage related curative effect and imaging data,compare the curative effect of the three kinds of operation method,Explain the advantages and disadvantages of each of the three methods.MethodsRetrospective analysis was performed on 60 patients who received lumbar intervertebral fusion(LIF)for lumbar spinal stenosis and degenerative spondylolisthesis in the First People’s Hospital of Yunnan Province from September 2018 to January 2020,and they were divided into 1 patients according to different surgical methods.Posterior approach lumbar interbody fusion group(PLIF),a total of 20 cases;2.Transforaminal approach lumbar interbody fusion(TLIF)treatment group,20 cases;3.The inclined lateral lumbar intervertebral fusion into the road(OLIF)treatment group,a total of 20 cases,records three groups of patients with operation time,blood loss,hospital stay,and preoperative and postoperative 3 months,6 months,1 year VAS,JOA,ODI score,measuring each review stage postoperative imaging data,statistical successfully blended ratio and adjacent vertebral disease’s occurrence,The therapeutic effect of the three surgical methods at each stage was evaluated systematically.ResultsAll the 60 patients successfully completed the operation,and all the patients were followed up 3 months,6 months and 1 year postoperatively.In the PLIF treatment group,the VAS score for lumbar and leg pain improved from 6.55±1.07 preoperatively to 1.90±0.99 at the last follow-up(significantly different from that before preoperatively,P<0.05),the JOA score increased from 10.75±2.02 before surgery to 21.60±2.85 at the last follow-up(P<0.05),the ODI score of low back pain decreased from 65.8± 11.29% before surgery to 21.2± 5.04% at the last follow-up(P<0.05),the incidence of adjacent segment degeneration(ASD)was 15%one year after surgery,and the fusion rate was 80% one year after surgery;In the TLIF group,VAS scores improved from 6.8±1.07 preoperatively to 1.85±1.06 at the last follow-up(P<0.05),JOA score increased from 11.1±1.94 before surgery to 22.4±2.80 at the last follow-up(P<0.05),the ODI score of low back pain decreased from 63.9± 12.9%preoperatively to 20.7± 6.16% at the last follow-up(P<0.05),the incidence of adjacent segment degeneration(ASD)was 5%,and the fusion rate was 85% one year after surgery;In the OLIF group,VAS scores improved from 6.7±1.27 preoperatively to 1.9±0.94 at the last follow-up(P<0.05),the JOA score increased from 10.45±2.01 before surgery to 21.70±2.34 at the last follow-up(P<0.05),the ODI score of low back pain decreased from 62.7± 8.83%before surgery to 20.2±3.54 at the last follow-up(P<0.05),the incidence of adjacent segment degeneration(ASD)was 5%,and the fusion rate was 90% one year after surgery.The VAS,JOA and ODI scores of the three treatment groups were significantly improved compared with those before surgery,and the OIF group had advantages over the PLIF and TLIF group in terms of operation time,intraoperative and postoperative blood loss,and discharge time.ConclusionThree kinds of lumbar fusion(PLIF,TLIF,OLIF)have the effect of relieving pain,improving function and improving quality of life for lumbar degenerative disease(LDD),and the long-term effect is satisfactory;2.Compared with PLIF and TLIF,OLIF has less trauma to patients and less intraoperative and postoperative bleeding,which is conducive to rehabilitation and conforms to the concept of minimally invasive surgery and accelerated surgical rehabilitation(ERAS).3.OLIF surgery has complications related to the approach,such as nerve,blood vessel,ureter,peritoneum,etc.So we should carefully evaluate the patient’s condition,master the indications,and reduce the complications caused by improper operation when using this operation.