Clinical Analysis Of Complications Of Oblique Lateral Interbody Fusion (PLIF)

Objective:Analyze the clinical efficacy of Oblique Lateral Interbody Fusion(OLIF);Summarize the complications of OLIF during the perioperative and follow-up period;Investigate potential influencing factors,and discuss prevention measures.Methods:A retrospective study was performed at the first affiliated hospital of Dalian medical university from June 2017 to September 2020.All patients have taken Oblique Lateral Interbody Fusion(OLIF)for treating lumbar degenerative diseases.A total of 59 patients were followed up,including 18 male patients and 41 female patients,with an average age of63.12±6.71 years.A total of 77 responsible segments were fused.43 people with single segment;16 people with multiple segments,including 14 people with double segments and 2people with three segments.Compare the preoperative and postoperative lumbar and lower limb Visual Analogue Scale(VAS)and Oswestry Disability Index(ODI)to evaluate the clinical efficacy;Compare the preoperative and postoperative height of intervertebral space of each responsible segments;and the area of intervertebral foramen to evaluate radiographic changes.Summarize and analyze the causes,prognosis and preventive measures of OLIF-related complications.Results:All patients were successfully completed the operation,the average operation time was93.83±25.26min per segment;the average intraoperative blood loss was 52.08±23.83ml per segment,and the average postoperative follow-up time was 6.10±2.43 months.Evaluation of clinical efficacy:the average preoperative and postoperative lumbar VAS were 5.44±2.71 and2.98±1.21 points,an average improvement of lumbar VAS was 2.46±2.44 points;the average preoperative and postoperative lower limb VAS were 5.14±2.15 and 1.93±0.79 points,an average improvement of lower limb VAS was 3.20±1.98 points;the average preoperative and postoperative ODI were 33.97±4.32 and 16.73±2.83,an average improvement of ODI was17.24±5.51.These indexes between preoperative and postoperative periods are different;and the differences were statistically significant.Radiographic evaluation:the preoperative and postoperative average height of intervertebral space were 9.36±2.16 and 15.41±2.09mm,,an average improvement rate was 74.96±57.96%;the preoperative and postoperative average intervertebral foraminal area were 1.53±0.40 and 2.25±0.47cm~2;an average improvement rate was 53.14±38.17%.Between the different periods of OLIF operation,there were significant differences,which was statistically significant.Complications:22 patients had operation-related complications.The total incidence of complications was 37.2%(22/59),including 1 cases(1.69%)with iliac lumbar vein injury,1 cases(1.69%)with intraoperative endplate damage,and 1 case(1.69%)with intraoperative Anterior Longitudinal Ligament injury;12 cases(20.34%)with postoperative dysfunction of hip flexion and left lower limb pain,4 cases(6.78%)with postoperative endplate collapse/Cage subsidence,1 case(1.69%)with recurrence and revision,both 1 case(1.69%)of nerve root injury and sympathetic chain injury.The patients with lower extremity complications and endplate/cage problems were treated as the study group,and the remaining patients were divided into the control group.The analysis found that the stretch time of psoas major in the lower extremity complications group was significantly longer than that in the control group,and the ratio of patients with multi-segment surgery was significantly higher than that in the control group.It is considered that the length of psoas major stretch time and the number of operation segments are the risk factors for lower limb complications of OLIF.The ratio of patients with endplate collapse/cage subsidence combined with osteoporosis is significantly higher than that of the control group.The difference is statistically significant.It is considered that osteoporosis is a risk factors for endplate collapse or cage subsidence of OLIFConclusion:OLIF has effective clinical efficacy for the treatment of lumbar degenerative diseases.It can obviously improve the height of the intervertebral space and the area of the intervertebral foramen at the responsible segment.OLIF has several kinds of complications,including dysfunction of hip flexion,lower limb pain,endplate damage or collapse,cage subsidence and so on.The length of psoas major stretch time and the number of surgical segments are potential risk factors for lower limb complications;while osteoporosis is a potential risk factor for endplate collapse or cage subsidence.