Comparative Analysis Of Adjacent Segment Degeneration After OLIF Versus TLIF

Background:Lumbar disc herniation(LDH)is one of the most common lumbar degenerative diseases,which causes low back pain and seriously affects people’s daily life.Patients with lumbar disc herniation who are ineffective after conservative treatment usually choose surgical treatment.Transforaminal lumbar interbody fusion(TLIF)is a classical method for the treatment of lumbar degenerative disease and has been widely used in the treatment of lumbar disc herniation,and achieved good clinical results,and has been recognized by many scholars.However,after long-term follow-up,it is found that there is a problem of adjacent segment degeneration(ASDeg)after lumbar interbody fusion.studies have found that the range of motion and stress of adjacent segments will be compensated after lumbar interbody fusion,resulting in one or more structural abnormalities,including vertebrae,intervertebral discs,facet joints,peripheral ligaments and paraspinal muscles,resulting in adjacent segment degeneration.With the aggravation of degeneration,waist and leg pain and nerve compression symptoms will gradually appear,which has become an important factor affecting the prognosis of patients.Some scholars have proposed that the protection of posterior ligament complex(PLC)plays an important role in reducing the occurrence of postoperative adjacent segmental diseases(ASDis).The posterior ligament complex,which includes supraspinous ligament,interspinous ligament,yellow ligament and articular capsule ligament,is an important part of the posterior column of the spine,which plays a role in supporting and connecting the vertebrae and maintaining the stability of the spine.In order to reduce the damage of the posterior complex,a more minimally invasive lumbar fusion via lateral oblique anterior approach(Oblique lateral interbody fusion,OLIF)was proposed.It is different from the traditional posterior approach,which places an operating channel in the physiological space between the anterior edge of the left psoas major muscle and the abdominal great vascular sheath.Indirect decompression of the spinal canal and intervertebral foramen can be achieved by inserting a larger interbody fusion device to open the intervertebral space.Its advantage is that it can retain the muscle and ligament tissue and bony structure of the diseased segments to the maximum extent,avoid the peeling of nerve tissue,reduce the risk of dura mater tear and reduce postoperative low back pain.The purpose of this study is to compare the imaging parameters of adjacent segments and the incidence of adjacent segment degeneration after OLIF and TLIF,in order to analyze the effect of OLIF and TLIF on postoperative adjacent segment degeneration,and to provide a basis for the choice of surgical approach for lumbar disc herniation.Objective:By comparing the clinical efficacy of OLIF and TLIF and the incidence of degeneration in adjacent segments,to explore the important role of PLC in the prevention of ASD.Methods:The clinical data of 69 patients with lumbar disc herniation treated by transforaminal interbody fusion(TLIF)and lateral anterior approach interbody fusion(OLIF)were collected in my hospital from January2018 to December 2021.According to the criteria of inclusion and exclusion,7 cases were excluded,5 cases lost follow-up,and 57 cases were included for study and analysis.According to the different surgical approaches,the patients were divided into OLIF group and TLIF group.The group of oblique anterior lumbar fusion(OLIF)has 21 cases.The ratio of male to female was 10:11,the age was 35 to 59 years old,with an average of(46.50 ±6.33)years.The follow-up period was 12 to 28 months(mean 21.31±4.00)months.The transforaminal lumbar fusion(TLIF)group has 36 cases.The ratio of male to female was 15:21,the age was39 to 59 years old,with an average of 48.41 ±5.97 years.Visual Analogue Score(VAS)and Oswestry disability index(ODI)were used to evaluate the clinical effect before and after operation,and the interbody height(DH)and dynamic angle change during flexion and extension(ROM)were measured by X-ray examination,and the adjacent intervertebral disc was evaluated by Pfirrmann grade and UCLA grade to evaluate the degeneration of adjacent segments.Results:1.There was no notable difference in age,sex,BMI,follow-up time and other general data between the two groups(P>0.05).2.The pain VAS score and ODI index of the two groups at the last follow-up were noticeably lower than those before operation(P<0.05).The VAS scores and ODI index at the last follow-up in the OLIF group were better than those in the TLIF group,but there was no noticeable difference(P>0.05).3.There was no notable difference in the preoperative adjacent segment space height and dynamic angle of the adjacent segment between the two groups.During the last postoperative follow-up,the adjacent segment space height was noticeably decreased between the two groups(P<0.05).The TLIF group was noticeably lower than the OLIF group in the L3/4 and L5/S1 intervertebral space height of the adjacent segment(P<0.05).At the last postoperative follow-up,the L3/4 and L5/S1 interbody dynamic Angle in TLIF group was higher than that in OLIF group(P<0.05),and the postoperative interbody height loss in TLIF group was more serious than that in OLIF group,with statistical significance(P<0.05).4.At the last follow-up,the incidence of ASD in the OLIF group was noticeably lower than that in the TLIF group when the adjacent segments of the intervertebral disc were evaluated by Pfirrmann and UCLA(P<0.05).Conclusion:1.OLIF group and TLIF group can achieve satisfactory clinical results in the treatment of lumbar disc herniation.2.OLIF compared with the TLIF can completely avoid the injury of lumbar posterior ligament complex and paraspinal muscles,can better protect the stability of lumbar intervertebral joint,thus reducing the incidence of postoperative adjacent segment degeneration.