Comparative Study Between Stand-alone Oblique Lumber Interbody Fusion And Posterior Lumbar Interbody Fusion In Treatment Of Lumbar Degenerative Diseases

Objective:To investigate the clinical value of oblique lateral approach interbody fusion by comparing the clinical efficacy of two surgical procedures,oblique lateral approach interbody fusion and posterior lumbar interbody fusion,in the treatment of mono-segmental lumbar degenerative diseases.Methods:The clinical data of patients with degenerative lumbar spine disease who attended the Third Hospital of Hebei Medical University and underwent mono-segmental lumbar fusion surgery from July 2017 to December 2018 were retrospectively analyzed.Statistics of Oblique Lumbar Interbody Fusion（OLIF stand-alone）and Posterior Lumbar Interbody Fusion（PLIF）two kinds of surgical data.Clinical data consisted of preoperative,7-day postoperative,and final follow-up visual analog scores（VAS）,Oswestry Dysfunction Index（ODI）,and Japanese Orthopaedic Association（JOA）scores,as well as operative time,blood loss,operative incision length,and length of stay.The imaging results included preoperative,immediate postoperative,and final follow-up intervertebral altitude of the operated segment,lumbar lordosis,anterior lordosis of the operated segment,and fusion rate of the operated segment at the final follow-up.In both groups,the incidence of perioperative surgery-related complications was calculated.Results:A total of 99 patients were included in this study,of whom 49were in the OLIF group and 50 were in the PLIF group.All patients were followed up for 24-38 months.Compared with patients in the PLIF group,the OLIF group had less operative time,intraoperative blood loss,incision length,and hospital stay than the PLIF group,with statistically significant differences（P operative time<0.001,P blood loss<0.001,P incision length<0.001,P hospital stay<0.007）.Comparison between groups showed that the OLIF group had better VAS scores,JOA scores,and ODI scores for low back pain and leg pain at 7 days postoperatively compared with the PLIF group,with statistically significant differences(P _{VAS of low back pain}<0.019,P _{VAS of leg pain}<0.001,P _ODI<0.033,P _JOA<0.043).There was no significant line difference in the comparison at the final follow-up(P _{VAS of low back pain}=0.179,P _{VAS of leg pain}=0.367,P _ODI=0.147,P _JOA=0.783).When comparing disc height between the two groups immediately after surgery,the OLIF group was statistically significantly better than the PLIF group(P _{disc height}=0.001).There was no significant difference in lumbar lordotic angle and operative segmental lordotic angle between the two groups（P lumbar lordotic angle=0.061,P operative segmental lordotic angle=0.074）.At the final follow-up,the OLIF group had a disc height compared to the two groups,with a statistically significant difference（P=0.034）.There was no significant difference in lumbar lordotic angle and operative segmental lordotic angle between the two groups（P lumbar lordotic angle=0.389,P operative segmental lordotic angle=0.231）.There was no significant difference in the fusion rate between the two groups at the last follow-up（P=0.505）.5 complications occurred in the OLIF group and 14 complications occurred in the PLIF group,with a statistically significant difference（P=0.025）.In the early postoperative period,the OLIF group had a better clinical outcome than the PLIF group.Conclusions:Depending on our results and early clinical experience,OLIF and PLIF are effective in the treatment of degenerative lumbar diseases.And compared with PLIF,OLIF has the advantages of less trauma,rapid postoperative recovery and noticeable improvement of symptoms,and the long-term effect needs to be followed up and studied with a large sample.