Clinical Outcomes And Radiographic Evaluation Of One-level Oblique Lateral Interbody Fusion In The Treatment Of Mild Degenerative Lumbar Spondylolisthesis

Objective: To evaluate clinical and radiographic outcomes of one-level oblique lumbar interbody fusion(OLIF)for the treatment of mild degenerative lumbar spondylolisthesis.Methods: Twenty-two patients with mild degenerative lumbar spondylolisthesis underwent OLIF and posterior percutaneous pedicle screw fixation from October 2014 to June 2017 in our hospital.There were 10 males and 12 females with ages from 45 to 66 years(average 56±5.6y).The operative level was 8 at L3-4 and 12 at L4-5,and all of cases were one-level lumbar spondylolisthesis.The operative duration,blood loss during operation,intra-operative and post-operative complications,post-operative hospital stay were recorded.The follow-up period was from 6 to 38 months.X-ray,CT scan and MRI scan images and clinical symptoms were evaluated before pre-operative and 6 months after surgery.Axial and sagittal diameters of the spinal canal and Cross sections of the spinal canal area were evaluated with MRI scan,disc height and degree of upper vertebral slip were measured by upright X-ray images,height of intervertebral foramina and cross-sectional areas of intervertebral foramina were evaluated using CT scan.Clinical outcomes were evaluated using Visual analogue scale(VAS),Oswestry disability index(ODI).Results: All of our cases underwent OLIF with posterior percutaneous pedicle screw fixation,the operation lasted for 170-220 min,with a mean duration of(196±16)min.Average operative blood loss was 170-300,with a mean 247±39ml.Average post-op hospital stay was 7-12 d,ranging 8.6±1.5d.The total incidence of complications was 31.8%(7/22),including 18.2% of intra-operative complications(4/22)and 13.6%(3/22)of post-operative complications.All symptoms were released or disappeared during follow-up.After surgery,significant increases in axial and sagittal spinal canal diameter(21.6% and 35.4%),spinal canal area(20.1%),disc height(65.8%),height of intervertebral foramina(12.0% on the right side,14.2% on the left side)and intervertebral foramen areas(18.2% on the right side,21.1% on the left side),and significant decrease of upper vertebral slip(-9%)were found(P<0.05).The VAS and ODI were significant decreased respectively.Compared with before operation,low back pain,leg pain and lower extremity numbness were significant reduced(P<0.05).Conclusion: OLIF was a novel technique for spinal minimally invasive surgical management.Significant improvements in disc height and spinal canal area were found through OLIF surgery.Herniated of discs was reduced through correction,and stretching the ligamentum flava may indirect decompress the spinal canal.OLIF was useful for mild degenerative lumbar spondylolisthesis with low back and leg symptoms.