| Objective: To introduce the application of oblique and anterior lumbar interbody fusion,combined with percutaneous pedicle screw fixation in the treatment of degenerative sagittal imbalance.compared with posterior lumbar interbody fusion and total facetectomy(SPO)to explore the correction ability and clinical effect of sagittal imbalance.Methods: A retrospective study was conducted on 67 patients who underwent multisegment fusion and fixation in our hospital from 2017 to 2020.According to the surgical methods,they were divided into two groups: oblique and anterior lumbar interbody fusion combined with percutaneous pedicle screw fixation(OLIF+ALIF group),posterior lumbar interbody fusion combined with facet joint resection group(PLIF+SPO group).The preoperative,postoperative and the last follow-up imaging parameters were compared between the two groups to explore the sagittal balance correction ability.The perioperative data,surgical complications,visual analogue scale(VAS)score,Oswestry disability index(ODI)and other related quality of life scores were compared to evaluate the clinical efficacy.Results: 26 patients in OLIF+ALIF group met the inclusion criteria.Compared with 41 patients in PLIF+SPO group,there was no significant difference in baseline information except age composition.All patients in both groups had operation performed smoothly,The operation time was(256.3 ± 52.7)min、intraoperative bleeding was(283.0 ±130.3)ml and the VAS score of lumbar incision 72 hours after operation was(1.85 ±0.97)in OLIF+ALIF group;the operation time,blood loss and VAS score was(164.0 ±38.7)min,(620.9 ± 295.0)ml and(2.66 ± 1.09)in PLIF+SPO group respectively,OLIF+ALIF group were better than PLIF+SPO group except operation time.67 patients were followed up for 6-36 months,At the last follow-up,the average improvement of lumbar lordosis was(13.4 ± 6.1)° in OLIF+ALIF group and(10.5 ± 9.7)° in PLIF+SPO group,there was no significant difference between the two groups;the improvement of SVA in OLIF+ALIF group was(33.2 ± 7.3)mm,PLIF+SPO group was(25.1 ± 10.4)mm,and there was significant difference between the two groups(t =3.47,P = 0.001).The angle and height of intervertebral space in OLIF operative lever were increased by(6.94 ± 3.86)° and(4.54 ± 2.01)mm,The angle and height of PLIF+SPO group in L1-L5 lever were increased by(4.85 ± 4.11)° and(2.83 ± 2.35)mm respectively.The improvement of angle and height between the two groups was statistically significant(P < 0.05).The angle and height of intervertebral space of ALIF operative lever in OLIF+ALIF group were increased by(3.77 ± 2.89)° and(3.93 ±2.85)mm,the L5/S1 lever in PLIF+SPO group were increased by(2.23 ± 4.67)°,(3.87± 3.02)mm,respectively.The improvement between the two groups was no significant difference(P > 0.05).The ODI index of OLIF+ALIF group recovered from(37.1 ± 5.8)to(14.5 ± 5.5)at the last follow-up,and PLIF+SPO group recovered from(38.8 ± 5.2)to(15.6 ± 3.7).There was statistically difference between last follow-up and preoperative in the two groups.The VAS scores of low back pain and leg pain of the two groups were also statistically different.The complication rates of OLIF+ALIF group and PLIF+SPO group were 53.8% and 36.5% respectively.The difference of complication rates was not statistically significance.At 3 months after operation,the fusion rate of OLIF+ALIF group was 83.6%,and PLIF+SPO group was 64.4%.There was significant difference between the two groups.At 6 months after operation,the fusion rate between the two groups was no significant difference.Conclusion: oblique and anterior lumbar interbody fusion,combined with percutaneous pedicle screw fixation can achieve good correction effect in the treatment of mild and moderate sagittal imbalance,and has the advantages of less intraoperative bleeding,low risk of nerve injury,less injury of paravertebral muscles and fast postoperative recovery,which can be used as a better treatment for lumbar degenerative diseases with sagittal imbalance. |
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