Clinical Study Of Oblique Lateral Interbody Fusion (OLIF)

Background:Degenerative lumbar diseases include lumbar disc herniation,secondary lumbar spinal stenosis,degenerative lumbar instability,slippage and degenerative lumbar scoliosis.Patients who did not alleviate the symptoms after strict conservative treatment,and there are simple decompression contraindications,need to consider the interbody fusion.Currently used in clinical minimally invasive interbody fusion are the following,extreme lateral interbody fusion(XLIF),oblique lateral interbody fusion(OLIF),minimally invasive transforaminal lumbar interbody fusion(mis-TLIF),Anterior Lumbar Interbody Fusion(OLIF)and axial lumbar interbody fusion(Axia LIF).Oblique lumber interbody fusion(OLIF)is a new minimally invasive technique in recent years.This technology has been carried out inland and abroad.In this study,the clinical efficacy of single-segment degenerative lumbar disease in line with OLIF indications was studied by analyzing the various indicators of surgery and clinical symptoms and imaging improvements.Objective:To study the clinical data of OLIF(oblique lateral interbody fusion)and find out the indications,safety and feasibility of this technique and to summarize the clinical efficacy and to draw conclusions about the advantages and disadvantages of this technique.Methods: A total of 19 patients with lumbar degenerative disease were treated with Oblique lateral interbody fusion with lateral nail internal fixation in our hospital from June to November 2017,with an average age of 62.68±6.25 years.All cases were single segmental,There were 8 cases of L3 / 4 and 11 cases of L4 / 5.There were 15 cases of degenerative lumbar spondylolisthesis and 4 cases of lumbar spinal stenosis.The operation time,intraoperative blood loss,VAS score and JOA score before and after operation and 3 months of follow-up,operative complications,preoperative and postoperative changes of intervertebral space and intervertebral foramen height were measured.Results:All the 19 patients completed the operation successfully,the main operation time was 133.47±32.13 min and the main intraoperative blood loss was 69.47±48.22 ml.All the patients were followed up for 3 months.The VAS score decreased from 7.68±0.95 to 2.16±0.77 on the first day after surgery and to 1.47±0.84 on the last follow-up(p <0.05),and the JOA score of lumbar increased from the preoperative 14.58±2.39 to the last Follow-up of 22.42±2.99 points;intervertebral height increased from 8.36±2.12 mm before surgery to 15.08±0.90 mm postoperatively,the intervertebral foramen height from the preoperative 17.65±2.91 mm to 21.52±2.30 mm postoperatively.Postoperative complications were found in 3 cases: postoperative transient left hip pain in 1 case,left side groin pain in 2 cases,to the last follow-up of patients,the above symptoms were significantly improved,no peritoneal perforation,colon perforation,ureteral injury and other related complications,no major vascular injury,fusion shift,intervertebral space infection and other serious complications disease.Oblique lateral approach doesn't need to separate the psoas muscle,thus reducing the risk of genital nerve or lumbar plexus injury.Because the rib arch and iliac crest limit its application to the head side and L5 / S1 level,this approach applies only to the L2-L5.Conclusions:1.Oblique lateral interbody fusion can be used in L2-L5 lumbar disease,intraoperative need without neural monitoring,operation does not enter the spinal canal,does not reveal the nerve,indirect decompression,and less bleeding surgery,can reduce nerve adhesion,hematoma,consistent with minimally invasive ideas.2.Oblique lateral interbody fusion with lateral nail internal fixation does not interfere with multifidus,without posterior incision,more beautiful,the recent clinical results are satisfactory,but the fusion rate and long-term efficacy still need long-term,Multi-center,large sample clinical observation.