Comparison Of Clinical Efficacy Between OLIF And TLIF In The Treatment Of L4-5 Single-stage Degenerative Lumbar Spondylolisthesis

OBJECTIVE: To investigate the clinical results between lateral lumbar intervertebral fusion(OLIF)and transforaminal lumbar interbody fusion(TLIF)in the treatment of degenerative lumbar spondylolisthesis.METHODS: From March 2017 to January 2019,45 patients with symptomatic I-II degree L4 degenerative spondylolisthesis were treated with decompression and fusion,including 20 patients in OLIF group and 25 patients in TLIF group.The incision length,operation time,intraoperative blood loss,drainage volume 3 days after surgery,and postoperative hospitalization time of the two groups were recorded and compared.The VAS score of lumbar and leg pain and ODI index before operation,1 month and 3 months after operation were evaluated and recorded.Meanwhile,sagittal parameters of the lumbar spine,such as lumbar lordosis angle [LL],intervertebral space height [DH],and intervertebral foramen height [FH],were also evaluated before operation and at the last follow-up.RESULTS: 45 patients were followed up for an average of 14.3 months.No large blood vessel injury,nerve root injury,loosening or fracture of internal fixation occurred in the two groups.Osseous fusion was achieved in all patients.In OLIF group,the incision length was(4.3±0.4)cm,the operative time was(92.4±7.2)min,the intraoperative blood loss was(91.4±6.5)ml,the postoperative 3d drainage volume was(85.3±23.6)ml,and the postoperative hospital stay was(5.4±0.6)days.In the TLIF group,the incision length was(8.2±0.3)cm,the operative time was(125.3±10.6)min,the intraoperative blood loss was(403.5±15.3)ml,the postoperative 3d drainage volume was(396.3±27.4)ml,and the postoperative hospital stay was(7.3±0.7)days.Compared with the TLIF group,the OLIF group had shorter incision length,shorter operation time,less intraoperative blood loss,less drainage 3 days after surgery,and shorter postoperative hospital stay,with statistically significant differences(P<0.05).The VAS score of lumbar and leg pain and ODI index in 1 month and 3 months after operation in the two groups were significantly different from those before operation(P<0.05),but there was no significant difference between the two groups after operation(P>0.05).At the last follow-up,LL,DH and FH of OLIF group were all greater than that of TLIF group,with statistically significant differences(all P < 0.05).At the last follow-up,LL in TLIF group showed no significant improvement compared with that before surgery,and the difference was not statistically significant(P > 0.05).CONCLUSION: For L4-5 patients with I-II degree degenerative lumbar spondylolisthesis,OLIF can obtain similar to TLIF surgery clinical effect,but OLIF is superior to TLIF in improving lumbar sagittal parameters.At the same time,OLIF has the advantages of less injury,shorter operation time,less blood loss during and after operation,and shorter hospitalization days after operation,which is worthy of clinical application.