| Objective: To analyze the clinical application and short-term efficacy of oblique lateral lumbar interbody fusion combined with posterior fixation in the treatment of degenerative lumbar scoliosis.Methods: A retrospective analysis of 19 cases of degenerative lumbar scoliosis treated with oblique lateral lumbar interbody fusion in our hospital from August 2017 to January 2019,including 6 males and 13 females,aged 53-70 years old,average(63.26 ± 5.65)years old.All patients had symptoms of low back pain,with a history of 5 to 18 years,with an average of(11.79 ± 3.51)years.There was no significant improvement in conservative treatment symptoms after 6 months of surgery.Among them,8 patients had lumbar spinal stenosis,3 patients had lumbar vertebrae I° slip,1 patient had lumbar vertebra II° slip,and 10 patients had pain in one lower limb.There were 2 to 4 surgical segments,with an average of(2.95 ± 0.78)segments.The vertebral segment involved 10 cases of L1/2,17 cases of L2/3,17 cases of L3/4,and 12 cases of L4/5.In this study,17 cases were combined with posterior internal fixation and 2 cases.After the second stage of internal fixation,both sides adopt the bilateral muscle gap approach.The clinical efficacy,operation time,intraoperative blood loss,hospitalization days and surgical complications were recorded.Cobb angle,lumbar Lord anterior(LL),and coronal balance were compared by preoperative and postoperative 3 months.(Coronal Vertical Axis,CVA),Sagittal Vertical Axis(SVA),Pelvic Incidence(PI),Pelvic Tilt(PT),Scoliosis Correction,Assessment of Perioperative Pain Visual Analogue Scale(VAS),Oswestry Dysfunction Index(ODI),Japanese Orthopaedic Association(JOA)score,and waist/leg pain improvement rate.Results: All patients successfully completed the operation,the operation time was(230.26±67.81)min;the intraoperative blood loss was(306.58±92.24)ml,and the hospital stay was(6.95±1.81)days.All patients underwent clinical and imaging follow-up.3 ~ 17 months,mean(11.21±4.21)months,no reduction in scoliosis correction during the follow-up period,internal fixation was in good condition,19 patients had an average scoliosis correction rate of 61.42%,and the waist/leg pain improvement rate was 64.88%.Pain visual analogue scale(VAS),Oswestry dysfunction index(ODI)and Japanese Orthopaedic Association(JOA)scores were significantly improved 3 months after surgery(P<0.05,P<0.05,P<0.05).Coronal parameters: Cobb angle and coronal balance(CVA)were significantly improved 3 months after surgery(P<0.05,P<0.05);sagittal parameters: 3 months postoperative lumbar lordosis(LL)and sagittal balance(SVA)were better than preoperative(P<0.05,P<0.05).Pelvic parameters: pelvic tilt angle(PT)and pelvic angle of incidence(PI)were similar to preoperative 3 months after surgery.The difference was not statistically significant(P>0.05,P>0.05).Seven patients had surgery-related complications: 1 patient had a cage position,2 patients had numbness on the anterior side of the thigh,and 1 patient had hip weakness,and was treated with nutritional nerves and fluid replacement for 1 month after surgery.Disappeared;2 cases of thigh skin temperature rise,postoperative symptomatic treatment,symptoms disappeared after 2 months;1 case of postoperative complications: 1 case of fat liquefaction in the back incision,7 days after dressing change incision recovery.There was no case of cage subsidence in this group of patients,and there were no serious complications such as intestinal obstruction,abdominal infection,vascular injury and ureteral injury.Conclusion: The oblique lateral lumbar interbody fusion combined with posterior internal fixation for the treatment of degenerative lumbar scoliosis is satisfactory,the clinical symptoms are relieved,and the balance of sagittal and coronal planes is effectively corrected.It is a treatment for degenerative lumbar vertebrae.Convex ideal surgery,long-term results still need long-term large sample follow-up. |
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