Comparison Of Clinical Efficacy Between OLIF And MIS-TLIF In The Treatment Of Single-segment Lumbar Degenerative Diseases

【Objective】To compare the clinical efficacy of oblique lateral lumbar interbody fusion(OLIF)and minimally invasive posterior lumbar transforaminal decompression and fusion(MIS-TLIF)in the treatment of single-segment lumbar degenerative diseases.【Methods】The data of patients who underwent OLIF and MIS-TLIF surgery for single-segment lumbar degenerative disease with radicular symptoms in Spine Surgery of Qinghai University Affiliated Hospital from September 2019 to September 2021 were retrospectively analyzed,including Lumbar Spinal Stenosis,Lumbar Disc herniation,Spondylolisthesis(Meyerding grade I-II°).Divided into two groups according to the operation method,and recorded the age,gender,operation segment,operation time,intraoperative blood loss,postoperative drainage,postoperative ambulation time,postoperative hospitalization time,preoperative and postoperative VAS score and ODI score of waist and legs at 1 month and 3 months after operation;the height of intervertebral space,intervertebral foramen,and lordosis angle of operative segment were measured by imaging system before and after operation,and lumbar fusion was judged at 12 months after operation condition.【Results】The operation time in the OLIF group was(303.13±33.42)min,and the operation time in the MIS-TLIF group was(221.72±50.04)min,and the operation time in the OLIF group was longer than that in the MIS-TLIF group.-The intraoperative blood loss in the TLIF group was(126.55±54.79)ml,and the OLIF group had less intraoperative blood loss than the MIS-TLIF group,and the difference was statistically significant(p<0.05).There was no significant difference in drainage volume,postoperative ambulation time and postoperative hospitalization recovery time(p>0.05);postoperative VAS pain scores and ODI scores of lower back and legs in OLIF group and MIS-TLIF group were lower than those before operation,the difference was statistically significant(p<0.05),and the pain score gradually decreased with the prolongation of recovery time;the VAS score of the lower back in the OLIF group was(3.38±1.17)at 1 month after the operation,and the VAS score of the lower back in the MIS-TLIF group was(4.48±0.74),and the VAS score of the lumbar back in the OLIF group was(1.83±0.92)three months after the operation,and the VAS score of the back in the MIS-TLIF group was(2.90±1.05).,the difference was statistically significant(p<0.05);there was no significant difference in leg VAS pain score and ODI score between OLIF group and MIS-TLIF group at 1month and 3 months after operation(p>0.05);OLIF The height of the intervertebral space in the MIS-TLIF group increased by(4.85±2.37)mm,and the height of the intervertebral space in the MIS-TLIF group increased by(2.03±1.36)mm,and the difference was statistically significant(p<0.05);the height of the intervertebral foramen in the OLIF group increased by(3.81±2.85)mm,the height of the intervertebral foramen in the MIS-TLIF group increased(1.03±0.83)mm,and the difference was statistically significant(p<0.05);the lordosis angle of the surgical segment in the OLIF group increased(5.02±4.91)°,and the surgical segment in the MIS-TLIF group increased by(5.02±4.91)°.The segmental lordotic angle increased(0.07±2.60)°,and the difference was statistically significant(p<0.05).At 12 months after operation,23 patients in the OLIF group achieved bone fusion,and 1 patient did not fuse,and the fusion rate was 95.83%.academic significance(p>0.05).At 12 months after operation,there was 1 case of Cage subsidence in the OLIF group and 2cases in the MIS-TLIF group,and the difference was not statistically significant(p>0.05).In the OLIF group,1 case of peritoneal injury and mild numbness of the left thigh occurred after operation.There were 2 cases of hip flexion weakness;1case of cerebrospinal fluid leakage,1 case of neurological dysfunction,and 1 case of incision fat liquefaction occurred in the MIS-TLIF group.【Conclusion】1.Although OLIF and MIS-TLIF have different decompression mechanisms,they both have good surgical outcomes for single-segment lumbar degenerative disease,and the mid-term and long-term outcomes are satisfactory;2.Relevant examinations need to be improved before surgery.According to the clinical and imaging characteristics of patients,surgical contraindications should be excluded,and an appropriate surgical method should be selected.When both surgical methods can be selected,OLIF can be a better choice;3.OLIF surgical approach is more in line with the concept of minimally invasive,less intraoperative bleeding,no bone tissue removal,no interference to the dural sac,nerve root,postoperative nerve root adhesion,lower extremity pain and muscle source It has the advantages of less chance of low back pain,higher interbody fusion rate,better imaging effect improvement,etc.;4.MIS-TLIF has a wide range of indications.The minimally invasive intervertebral foraminal approach has little iatrogenic damage to the paravertebral muscle tissue,without pulling the dural sac and nerve roots,reducing the risk of nerve damage.The scar adhesion caused by the first operation also reduces the difficulty of revision surgery,with less intraoperative blood loss,earlier postoperative walking time,less postoperative analgesic drug dosage,higher fusion rate,and shorter learning curve.