The Early Efficacy Of Posterior Lumbar Interbody Fusion And Oblique Lateral Lumbar Interbody Fusion In The Treatment Of Degenerative Lumbar Diseases:A Meta-analysis

Objective:At present,lumbar interbody fusion is considered as one of the effective ways to treat degenerative diseases of the lumbar spine.PLIF and TLIF are the most commonly used surgical methods for spine surgeons.In recent years,with the in-depth development and gradual improvement of minimally invasive treatment,the concept of small trauma and rapid recovery has also promoted the development of lumbar interbody fusion,thus giving birth to oblique lateral lumbar interbody fusion.Two different approaches have been reported to achieve satisfactory results in the treatment of degenerative diseases of the lumbar spine,but it is rare to compare the advantages and disadvantages of the two approaches in the treatment of degenerative diseases of the lumbar spine.Literature reports were collected to compare the advantages and disadvantages of traditional posterior lumbar interbody fusion and the new oblique lateral lumbar interbody fusion by meta analysis,providing strong evidence for clinical decisions.Methods:Randomized controlled trials(RCTs)of posterior lumbar intervertebral fusion and oblique lateral lumbar intervertebral fusion from 1980 to October 2018 were retrieved in PUBMED,Embase,Ovid Technologies,Medline,CNKI,Wanfang Data,Chinese biomedical database,VIP database and Cochrane Collaboration Library.Relevant randomized trials,retrospective trials,etc.Data were summarized from the included literature,and the quality of the randomized controlled studies was assessed by the evidence in the literature according to Grade guidelines,and the retrospective study trials were graded by the Newcastle-Ottawa scale.Results:A total of 8 literatures were included after retrieval,including 2 randomized controlled trials that met the standards and 6 retrospective studies.In this meta analysis,clinical satisfaction was 88.3% for OLIF group and 86.6% for TLIF/ PLIF group,respectively,with no statistically significant difference(OR=1.10,95% CI = 0.80--1.50,P = 0.56);The total incidence of perioperative complications was higher in the TLIF/PLIF group(9.4%)than in the OLIF group(6.3%),and the difference was statistically significant(OR=0.67,95% CI = 0.45--0.99,P = 0.04);There was no statistically significant difference VAS score(MDs = 0.02,95% CI = 0.13-0.08,P = 0.70).ODI score difference was statistically significant(MDs = 0.86,95% CI = 1.63-0.10,P=0.03).Intraoperative blood loss was statistically significant((MDs=-247.83,95% CI=-261.04---234.62,P<0.00001).The difference in operation duration was statistically significant((MDs=-50.11,95%CI=-63.34---36.88,P<0.00001).Postoperative drainage difference was statistically significant(MDs=-32.30,95%CI=-39.98---24.61,P<0.00001).Conclusions:To sum up,domestic and foreign studies in recent years have found no statistical difference in clinical satisfaction and VAS score between oblique lateral lumbar interbody fusion and traditional posterior lumbar interbody fusion.Both procedures have the same advantage in alleviating symptoms.However,in terms of complications,ODI score,duration of operation,intraoperative blood loss,and postoperative drainage,oblique lateral lumbar interbody fusion is more advantageous,and the hidden benefits brought by rapid postoperative rehabilitation cannot be underestimated.In order to further deepen the conclusion,it is necessary to design more rigorous,detailed and uniform objective indicators of random control.