Clinical Observation Of Oblique Lumbar Interbody Fusion Combined With Unilateral Pedicle Screw Fixation Through WILTSE Approach In The Treatment Of Single-Segment Lumbar Degenerative Diseases

Objective To evaluate the efficacy of oblique lumbar interbody fusion(OLIF)combined with unilateral pedicle screw fixation through Wiltse approach in the treatment of single-segment lumbar degenerative diseases.Methods From July 2017 to July 2020,one hundred and twenty patients with lumbar degenerative diseases were treated with OLIF combined with Wiltse approach unilateral pedicle screw fixation,including 56 males and 64 females,aged from 41 to 75 years,with an average age of(56.7±9.2)years.The operation time,intraoperative blood loss and complications were recorded,and the clinical effect was evaluated by visual analog score of low back pain and leg pain before and after operation,(ODI)and SF-36 score scale,lumbar X-ray film and lumbar magnetic resonance were taken 3 days after operation,the height of intervertebral space,intervertebral foramen area and spinal canal area were measured,and interbody fusion was evaluated according to CT half a year after operation.Results The average operation time was(110.5 ± 12.1)min,and the average intraoperative blood loss was(70.5±16.8)ml.The VAS score of low back pain,leg pain and ODI dysfunction index decreased from(5.6±1.4),(6.0±1.2)and(60.8 %±12.2%)preoperation to(1.6±0.4),(2.1±0.6)and(17.2%±8.0%)at the last follow-up,respectively.The SF-36 scale increased from(36.8 ± 4.6)to(65.0 ± 10.1)at the last follow-up.The differences were statistically significant(P<0.05).The intervertebral space height,intervertebral foramen height,intervertebral foramen area and spinal canal area were significantly improved 3 days postoperation,and CT showed that 2 cases had poor fusion and the other 118 cases had good fusion 6 months after operation.The total fusion rate is 98.3%(118/120).The overall incidence of complications was 16.7%(20/120),transient iliopsoas muscle weakness in 6 cases(5.0%),endplate fracture in 3 cases(2.5%),peritoneal injury in 2cases(1.7%),postoperative hematoma in 1 case(0.8%),fusion cage settlement in 8 cases(6.7%).The postoperative follow-up of 2 patients showed that the fusion cage subsidence(II°),and the symptoms were relieved after revision operation.All complications were relieved or disappeared in varying degrees during the follow-up period,and there were no complications such as cage displacement,screw fracture and so on.Conclusion Under the premise of strictly grasping the indications,OLIF combined with Wiltse unilateral pedicle screw fixation is effective in the treatment of single-segment lumbar degenerative diseases with minimally invasive advantages such as less trauma and less complications.it is a safe and effective treatment.