Observation On The Efficacy Of OLIF Combined With Posterior Internal Fixation In The Treatment Of Lumbar Degenerative Diseases

Objective:To explore the feasibility of OLIF combined with posterior internal fixation in the treatment of lumbar degenerative diseases and its clinical efficacy in the treatment of lumbar degenerative diseases.Methods:From January 1,2018 to December 1,2021,61 patients with lumbar degenerative diseases who underwent OLIF combined with posterior internal fixation in the Department of Spinal Orthopedics,Yijishan Hospital,Wannan Medical College were retrospectively analyzed.The age,course of disease,gender,BMI,BMD(T-score),operation time,intraoperative blood loss,surgical segment,height and length of fusion cage,intraoperative blood loss,operation time,hospitalization time,postoperative complications and other related data of all patients were recorded.Oswestry disability index(ODI)and visual analogue scale(VAS)were used to evaluate the symptoms and neurological function of all patients before and after operation.Lumbar lordosis(LL),disc height(DH),foraminal height(FH),foraminal area(FA),dural sac area(DSA)and pelvic incidence(PI)were measured preoperatively and postoperatively.Pelvic tilt(PT)and sacral slope(SS).RESULTS:Of the 61 patients with lumbar degenerative diseases,the male to female ratio was 26:35,the age was(64.51±10.38)years old,and the course of disease lasted(38.93±53.40)months.The body mass index(BMI)was(24.11±2.84)kg/m2,and the bone mineral density(BMD)was(-0.7±1.6).The number of surgical stages was L4/5(39 cases),L3/4,L4/5(16 cases),L2/3,L3/4,L4/5(6 cases).The intraoperative blood loss was 112.46±87.3 ml,and the operation time was 2.94±1.02 hours.Hospital stay was 10.64±2.54 days(minimum 5 days,maximum 18 days).The height of 10 mm,12 mm and 14 mm fusion cages were used in 19,51 and 19segments respectively.The length of 50 mm and 55 mm fusion cages were used in 60and 29 segments respectively.Postoperative complications:1 case of venous vascular injury,2 cases of postoperative residual symptoms,8 cases of fusion cage sinking,VAS score decreased from 5.74±0.73 before operation to 2.05±0.67(last follow-up);o DI decreased from 58.93±3.75%to 20.82±2.88%(last follow-up).DH increased from 0.95±0.255 cm preoperatively to 1.315±0.226 cm at last follow-up.FH increased from 1.597±0.346 cm to 1.979±0.256 cm.DSA increased from 0.875±0.377 cm~2 to 1.059±0.39 cm~2.PT decreased from 21.67°±8.13°to 18.24°±5.92°.SS increased from 30.23°±7.47°preoperatively to 33.44°±10.1°at the last follow-up.LL increased from 42.39°±9.62°preoperatively to 49.38°±9.8°at the latest follow-up.The differences of VAS,ODI,DH,FH,DSA,PT,SS and LL were statistically significant(P<0.05).PI changed from 51.77°±9.71°to 52.33°±10.07°,and the difference was not statistically significant(P=0.445).Conclusion:OLIF combined with posterior internal fixation is effective in the treatment of indirect decompression of lumbar degenerative diseases.It can effectively restore the sagittal balance of spine/pelvis and help to improve the clinical symptoms of patients.