Clinical Analysis Of Microscope-assisted Oblique Lateral Interbody Fusion In Treatment Of Lumbar Degenerative Disease

Objective.In order to explore the feasibility of a surgical treatment,oblique lateral interbody fusion(OLIF),in geriatric patients,we compared perioperative parameters,clinical outcomes,and complications of lumbar degenerative disc disease in two groups of studies.One group was under the operation of OLIF,and the other group was under the operation of posterior lateral interbody fusion(PLIF).Methods.There were 48 geriatric patients with lumbar degenerative disease(Lumbar 4/5 disc degeneration disease only)enrolled in this study since August,2015 to January,2017.These patients were divided into OLIF(n=24)group,and PLIF(n=24)group.All of the patients were diagnosed clearly and were in conformity with the inclusion criteria.The composition of age and gender in the two groups is comparable.The evaluation parameters include the length of skin incision,operation time,intraoperative blood loss,postoperative bed time,pain severity of incision in postoperative,and changes of postoperative inflammatory.We comprared the lumbar function,fusion rate,recent and long term complications in these patients in the follow-up visitings.The statistical software SPSS19.0 was used to analyze the data.Results.1.There was no significant difference in average age,gender composition,preoperative low back pain score and preoperative IDH/IDF in both groups(P>0.05),which indicated that the two groups of patients were comparable.2.The perioperative parameters of the two groups were analyzed after the operation.We found that OLIF group had shorter length of skin incision(4.82±0.40 centimeter)compared with PLIF group(7.08±0.68 centimeter).OLIF group had significantly less blood loss(162.5±56.4 milliliter)compared with PLIF group(230.6±54.6 milliliter).OLIF group had shorter postoperative bed time(1.35±0.84 days)compared with PLIF group(3.26±1.24 days).They were statistically significant(P < 0.001).But there was no difference on operation time between OLIF group(135.0±13.2minutes)and PLIF group(130.6±12.5minutes).The results showed that OLIF group had less invasive and bleeding loss in the operation.And the bedtime of OLIF group was shorter than that of PLIF group.However,there was no significant difference in the operation time between the two groups.3.We compared the postoperative low back pain and incision pain between the two groups.In terms of the VAS score of low back pain,there was no significant difference between them(P>0.05).Both groups showed the severe symptoms of low back pain.While there was significant difference in the VAS score of incision pain(P < 0.05).There was no significant difference in serum CRP 24 hours before and after operation(P > 0.05)between these two groups).But the CRP of PLIF group was higher than in OLIF group both 24 h and 48 h after operation(P < 0.05).It showed that lighter incision pain in OLIF group than in PLIF group.This indicates that the operationof OLIF is less invasive.4.We compared the postoperative lumbar function between the two groups.The Oswestry disability index(ODI)in OLIF group before operation was(59.2±10.4)% compared with PLIF group(62.6±11.8)%.There was no significant difference between the two groups(P>0.05).Both groups had poor lumbar function.After the operation,the ODI in OLIF group was(13.2±2.7)% compared with PLIF group(14.1±3.0)%.Even though there was no significant difference between the two groups(P>0.05),there was a significant decrease in the ODI scores before and after operation(P < 0.05)in both groups.It suggests these two operative methods can promote the recovery of lumbar function efficiently.Based on the similar ODI scores between the two groups(P*=0.70),it indicates that the effect of two operative methods on improving lumbar function is comparable.There was no significant difference in the fusion rate between the two groups(P*=1.00).In terms of the JOA score of low back pain at one week after operation,OLIF group was higher than PLIF group(P < 0.05),which indicates that the recovery rate of OLIF group is higher.5.We compared the short-term and long-term complication between the two groups.In OLIF group,there were 2 cases of complications after operation.The percentage of incidence was 8.33%.One of the patients sensed the cauterization of the inner thighs,and the other one felt the numbness and fatigue of the thighs.In PLIF group,there were 4 cases of complicationsafter operation.The percentage of complication incidence was 16.66%.Two of them had cerebral fluid leakage,and the other twocases showed nerve root injury.The results of recent complications were statiscally analyzed(P>0.05).We also compared the subsidence of interbody fusion(cage)between the two groups.OLIF group had 3 cases of cage subsidence,while PLIF group had 2cases.There was no significant difference(P>0.05)between them.All above suggests that there was no significant difference in the incidence of postoperative complications between OLIF and PLIF operations.Conclusion The Clinical Outcome of OLIF by microscopy in treating degenerative diseases of the lumbar spine is as satisfactory as that of PLIF.There is no difference between the operation time and the complications.But it has a small incision,less bleeding loss,more precise operation and faster recovery through utilizing OLIF.It is a safe,effective and minimally invasive procedure for single-segment lumbar degenerative disc disease.