Comparative Efficacy And Imaging Analysis Of Lateral Versus Posterior Approaches In Single-segment Lumbar Fusion For Degenerative Lumbar Spine Disease

Objective: To compare the efficacy and imaging data of lateral versus posterior lumbar fusion in the treatment of single-segment lumbar degenerative disease and to investigate the factors influencing postoperative outcomesMethods: Patients who were admitted to the Department of Orthopedics of the First Affiliated Hospital of Kunming Medical University from January 2020 to December 2022 with a diagnosis of "lumbar degenerative disease" and treated with single-segment lumbar interbody fusion were retrospectively studied and followed up until January 2023,and were divided into: posterior access group and lateral access group according to the different surgical approaches.Collect clinical information on the patient,including:1.general information: gender,age,body mass index(BMI),bone mass(measured by QCT)duration of disease,distribution of disease types;2.perioperative data: duration of surgery,intraoperative bleeding,length of hospital stay;3.clinical outcome indicators: assessed preoperatively,3 days postoperatively(later: postoperative)and at the final follow-up(later: final),including: visual analogue score for low back pain(VAS-BP),visual analogue score for leg pain(VAS-LP),Oswestry dysfunction index(ODI);4.Imaging data:(1)Measurement of foraminal height(FH),intervertebral space height(DH)and cross-sectional area of the spinal canal(SCSA)at preoperative,postoperative and final visits,and recording of the difference between postoperative and preoperative measurements(postoperative improvement value)and the difference between final and preoperative measurements(final improvement value);(2)Measurement of the fusion settling rate at the end follow-up and recording of the fusion;(3)Assessment of disc degeneration,small joint degeneration and spinal stenosis.5.Complications: Collect the incidence of early complications and distant complications.The above clinical data were compared and the efficacy of the two groups as well as the imaging data were analysed.Patients were then classified as "excellent,good,acceptable or poor" according to the ODI index,and those who were "acceptable or poor" were included in the group with incomplete remission,while those who were "excellent or good" were included in the group with symptomatic remission.A binary logistic regression was performed to investigate the factors influencing the postoperative outcomes of the two procedures.Results: A total of 126 patients were included,including 83 in the posterior approach group and 43 in the lateral approach group.1.The VAS low back pain scores,VAS leg pain scores and ODI scores of patients in both groups were significantly improved after surgery and at the final follow-up compared with those before surgery(P < 0.001).2.Comparing the perioperative data of the two groups,there was a statistical difference between the posterior approach group and the lateral approach group in terms of operative time and blood loss(P < 0.05).3.Comparing the imaging data of the two groups: postoperative DH,last DH,postoperative DH improvement value and last DH improvement were statistically significant(P < 0.05);postoperative FH,last FH,postoperative FH improvement value and last FH improvement value were statistically significant(P < 0.001);last SCSA and last SCSA improvement value were statistically significant(P < 0.001).4.Binary logistic regression analysis revealed a possible correlation between disc degeneration and postoperative outcome in the posterior approach group(OR=5.510,95%Cl 2.393-12.687,P<0.001);a possible correlation between spinal stenosis and postoperative outcome in the lateral approach group(OR=3.357,95%Cl 1.199-9.398,P< 0.001;OR=2.531,95%Cl 0.865-7.407,P<0.001).Conclusion:1.Both lateral approach surgery and posterior approach surgery were effective in treating single-segment LDD,and both showed significant improvements in clinical outcomes and imaging parameters in the postoperative period and at the final followup compared to the preoperative period,and had similar outcomes.2.The lateral approach group had less blood loss,shorter operative time,better postoperative DH,final DH,postoperative DH improvement,final DH improvement,postoperative FH,postoperative FH improvement,final FH improvement and lower fusion settling rate;the posterior approach group had better final SCSA and final SCSA improvement.3.There may be a correlation between disc degeneration and postoperative outcome in the posterior approach group;there may be a correlation between spinal stenosis and postoperative outcome in the lateral approach group.