The Initial Clinical Efficacy And Imaging Evaluation Of Lateral Lumbar Interbody Fusion In The Treatment Of Degenerative Lumbar Spondylolisthesis

Objective:To observe the initial clinical efficacy and imaging data of Lateral Lumbar Interbody Fusion(LLIF) in the treatment of degenerative lumbar spondylolisthesis(DLS),and to explore the feasibility and advantages of this procedure.Methods:From December 2017 to December 2019,43 patients with lumbar degenerative spondylolisthesis were treated with LLIF in the Second Hospital of Shanxi Medical University,including 27 females and 16 males;aged 43-72 (61.86±7.86) years old.There are 51 surgical segments in total.For all patients,general data collection and preoperative,postoperative and final follow-up clinical efficacy indicators and imaging indicators were collected.Clinical efficacy indicators include lumbar JOA(Japanese Orthopaedic Association)score,pain visual analogue scale (VAS)score,and Oswestry disability index(ODI).Imaging indicators include : disc height (DH),slipping length (SL),slipping rate(SR),lumbar lordosis(LL) and Surgical segmental curvature (Segmental Disc Angle,SDA),which all were measured on X-ray;Spinal canal diameter (SCD),cross-sectional spinal canal area (CSA)and thickness of ligamentum flavum(TLF)at the narrowest part of the MRI cross-section.Compare the differences among preoperative,postoperative and last follow-up based on clinical efficacy indexes and imaging indexes.Results:All operations were successfully completed in one or two stages.The operation time of each segment was 110.35±20.17min(100-230min),and the blood loss per segment was 20.34±5.81ml(10-50ml).The JOA score increased from 12.17 ± 2.21 preoperatively to 24.27 ± 2.01 postoperatively,which was 25.31±2.89 at the last time.The JOA score at the last time was significantly higher than that before operation(P < 0.05),and the improvement rate was 78.19%.The preoperative VAS score was 6.74±1.11 points,postoperatively reduced to 1.78±0.31 points,and the final VAS score was 1.33±0.29 points.The final VAS score was significantly lower than that before the operation(P<0.05).The postoperative ODI was 18.38±2.47,and the last follow-up was 16.51±2.34.Compared with 42.58±4.68 before operation,there was also a significant decrease(P<0.05).The DH,SR,LL,SDA、SCD、CSA and TLF of the last surgical segment were significantly improved(P<0.05).Five of them were completely reset.At the last follow-up,the fusion rate was 100%.There were 2 cases of subsidence,and the subsidence rates were 28% and 33%,respectively,belonging to grade I.Nine patients had transient numbness in the front of the left thigh after the operation,and 2 patients had transient weakness in flexion of the left lower extremity after the operation,and both subsided or disappeared within 1-6 weeks after the operation.No serious complications such as incision infection,cerebrospinal fluid leakage,large blood vessel damage,and genital femoral nerve damage occurred.All patients were followed up continuously,the follow-up time was 3~23 months(14.39±8.18 months).Conclusion:From the initial efficacy point of view,LLIF is feasible to treat DLS,and it can achieve good efficacy in relieving low back pain and lower limb pain.The imaging indicators of each group were also significantly improved postoperatively and at the last follow-up compared with preoperatively,indicating that indirect decompression via LLIF,DH,SR,LL,SDA、SCD、CSA and TLF have been significantly improved.