Comparison Of Outcomes Between Oblique LIF Combined With Percutaneous Pedicle Screw And Transforaminal LIF In Lumbar Degenerative Disease

Objective:To investigate the comparison of clinical efficacy and lumbar imaging parameters of oblique lateral interbody fusion combined with percutaneous pedicle screw fixation and transforaminal lumbar interbody fusion in the treatment of lumbar degenerative disease.Methods:A total of 56 patients who underwent OLIF combined with percutaneous pedicle screw fixation and TLIF in the Department of Spinal orthopedics,the First Affiliated Hospital of Wannan Medical College from May 2017 to November 2021were retrospectively studied,and the fused vertebral space was all at the L4/5 level.All patients had complete clinical data.There were 24 patients in the combined OLIF group,including 10 males and 14 females.There were 32 patients in the TLIF group,including 9 males and 23 females.The gender,age,BMI,follow-up time,operation time,intraoperative blood loss and postoperative hospital stay of all patients were collected.Visual analogue scale(VAS)was used to evaluate low back pain and leg pain,and Oswestry disability index(ODI)was used to evaluate function before operation,at 1 week,3 months after operation and at the last follow-up.Radiographic parameters,including disc height(DH),foraminal height(FH),lumbar lordosis(LL)and fusion segment lordosis(FSL),were measured before operation,at 1 week,3months after operation and at the last follow-up.Results:In the combined OLIF group,the average age was 62.54±10.44 years,the average BMI was 24.17±2.67kg/m~2,the average follow-up time was 13.63±4.05months,the average operation time was 143.00±31.85 minutes,and the average intraoperative blood loss was 98.75±21.53ml.The average postoperative hospital stay was 5.00±1.35 days.In the TLIF group,the average age was 56.16±9.77 years,the average BMI was 23.93±3.75kg/m~2,the average follow-up time was 13.69±5.11months,the average operation time was 173.00±26.54 minutes,and the average intraoperative blood loss was 338.75±73.91ml.The average postoperative hospital stay was 7.91±2.82 days.In the combined OLIF group,the VAS and ODI scores decreased from 4.17±1.43 and 58.93±11.54%before operation to 1.67±1.05 and 14.45±3.40%at the last follow-up,and the differences were statistically significant(P<0.05).In TLIF group,the VAS score at 1 week after operation was significantly higher than that before operation,and it was significantly lower than that at 3 months after operation and at the last follow-up(P<0.05).The ODI score decreased from 59.95±10.47%before operation to 14.17±1.46%at the last follow-up(P<0.05).The VAS and ODI scores in Combined OLIF group were significantly lower than those in TLIF group at 1week after operation(P<0.05),and there was no significant difference in VAS and ODI scores between the two groups at the last follow-up(P>0.05).The DH and FH of the two groups at 1 week after operation were higher than those before operation,and the DH and FH of the two groups at 3 months after operation and the last follow-up were lower than those at 1 week after operation,but still higher than those before operation,the differences were statistically significant(P<0.05).The DH in combined OLIF group was higher than that in TLIF group at 1 week,3 months and last follow-up after operation,and the FH in combined OLIF group was higher than that in TLIF group at 1 week and 3 months after operation,and the differences were statistically significant(P<0.05).In combined OLIF group,the LL was increased from 49.68±10.06°before operation to 54.56±10.17°at the last follow-up(P<0.05).The LL in combined OLIF group was greater than that in TLIF group at 3 months after operation and the last follow-up(P<0.05).There was no significant difference in FSL between the two groups.The combined OLIF group’s cage subsidence rate was lower than that in the TLIF group at 3 months after operation and the last follow-up,and its fusion rate was also lower than that in the TLIF group at the last follow-up.Conclusion:Both OLIF and TLIF achieved good clinical efficacy in the long-term follow-up,and both achieved a certain degree of recovery of DH and FH,and obtained good fusion rate,and neither of them had severe cage subsidence.In the short-term follow-up,Combined OLIF was superior to TLIF in relieving pain,restoring function and increasing lumbar lordosis.However,the fusion rate of TLIF was higher than that of combined OLIF at final follow-up.