The Clinical Efficacy Of Oblique Lateral Lumbar Interbody Fusion Combined With Percutaneous Endoscopic Lumbar Discectomy In The Treatment Of Adjacent Segment Degeneration After Lumbar Surgery

Objective:To analyze and compare the clinical efficacy of oblique lateral lumbar interbody fusion(OLIF)combined with percutaneous endoscopic lumbar discectomy(PELD)and traditional posterior surgery(PLIF)in the treatment of adjacent segment degeneration(ASD)after lumbar fusion,and to provide a more minimally invasive scheme for the treatment of adjacent segment degeneration after lumbar surgery.Methods:Retrospective analysis of 39 cases who underwent adjacent segment degeneration were treated by orthopedic surgery in Shanxi Bethune Hospital,from 2015 to 2019.The patients were divided into two groups,OLIF-PELD group and PLIF group according to the operation method.There were 22 cases in the OLIF-PELD group,of which 14 were male and 8 were female.The previous operative segments were L4-S1 5,L4-L5 7,L3-L5 6 and L3-S1 4.There were 17 cases in PLIF group,of which 9 were male and 8 were female.The previous operative segments were L4-S1 6 cases,L4-L5 5 cases,L3-L5 4 cases,L3-S1 6 cases.The difference of visual pain analogue score of lower extremity(VAS),evaluation of treatment score(JOA)and Oswestry dysfunction index score(ODI),operation time,blood loss during operation,time of out-of-bed were recorded and analyzed by statistical method.Results:All patients completed the operation successfully,of which 22 underwent OLIF-PELD surgery and 17 underwent PLIF surgery.There was no statistical difference in age,sex,segments of previous operation between the two groups.Compared with PLIF,OLIF-PELD had shorter operation time,less intraoperative bleeding and early time of out-of-bed.There was no significant difference in preoperative and postoperative 6 and 12 months in VAS,ODI and JOA scores between the two groups.In 1 month after operation,the postoperative pain and the effect of postoperative functional state in OLIF-PELD group was less than that in PLIF group.The ODI score of OLIF-PELD group was lower than PLIF group in 1 month and 3 months,OLIF-PELD has better function in 1 month and 3 months than PLIF.OLIF-PELD shows the short operation time,less bleeding,and better clinical efficacy at 1 month and 3 months,but there is no significant difference between 6 months and 12 months.Conclusion:OLIF-PELD and traditional PLIF are effective method to treat adjacent segment degeneration after lumbar surgery.OLIF-PELD compared with traditional PLIF,the clinical early-term efficacy of the two methods is similar,but the former has short operation time,less intraoperative bleeding,and quick postoperative recovery,which can be used as a minimally invasive treatment of adjacent segment degeneration after lumbar fusion.