Comparison of Simultaneous Single-position Oblique Lumbar Interbody Fusion and Percutaneous Pedicle Screw Fixation with Posterior Lumbar Interbody Fusion using O-arm Navigated C-arm free Technique for Lumbar Degenerative Diseases

Background: To compare the clinical, surgical and radiographic outcomes of O-arm navigated C-arm free, simultaneous single-position oblique lumbar interbody fusion (OLIF) and percutaneous pedicle screw (PPS) fixation with minimally invasive posterior/ transforaminal lumbar interbody fusion (MI-PLIF/TLIF).Methods: This is retrospective comparative study. The study included 98 patients, 63 in single position OLIF (group SO) and 35 in MI-PLIF/TLIF (group P/T). Surgical time, blood loss, mobilization time after surgery and complications were analyzed for all patients. Clinical evaluation included visual analog scale (VAS) for back pain, oswestry disability index (ODI). Radiological parameters included cage height (CH), cage to disc ratio (CDR), DH change, pre and postoperative disc height (DH), foraminal height (FH), foraminal area (FA), segmental lordosis (SL). Results: In group SO (vs group P/T), surgical time, blood loss and mobilization time were 117.7± 34.1 minutes (171.8 ± 40.6 minutes, p<0.000001), 139.2 ± 82.0 ml (vs. 374.2 ± 247.7 ml, p<0.000001) and 2.7 ±1 .0 days (vs 3.9 ± 2.4 days, p<0.000001) respectively. The CH, CDR, DH change and postoperative DH, FH, FA increase were statistically significant in group SO compared to group P/T. VAS and ODI improvement were similar in both groups. Mobilization time is shorter in group SO. Total complication rate in group SO was 7% while that in group P/T was 11%. Conclusions: Simultaneous single position O-arm navigated C-arm free OLIF reduces the surgical time, blood loss, mobilization time after operation without the risk of an adverse event of intraoperative radiation to operating staff. Good indirect decompression can be achieved with this method. Clinical results were similar in both groups.

Additional lateral plate fixation has no effect to prevent cage subsidence in oblique lumbar interbody fusion

Background For lumbar degenerative diseases, cage subsidence is a serious complication and can result in the failure of indirect decompression in the oblique lumbar interbody fusion (OLIF) procedure. Whether additional lateral plate fixation was effective to improve clinical outcomes and prevent cage subsidence was still unknown. This study aimed to compare the incidence and degree of cage subsidence between stand-alone oblique lumbar interbody fusion (SA-OLIF) and OLIF combined with lateral plate fixation (OLIF + LP) for the treatment of lumbar degenerative diseases and to evaluate the effect of the lateral plate fixation. Methods This was a retrospective comparative study. 20 patients with 21 levels underwent SA-OLIF and 21 patients with 26 levels underwent OLIF + LP. We compared clinical and radiographic outcomes between two groups. Clinical evaluation included Visual Analog Scale (VAS) for back pain and leg pain, Japanese Orthopaedic Association (JOA) scores and Oswestry Disability Index (ODI). Radiographical evaluation included disc height (DH), segmental lordosis angle (SL), and subsidence rate on standing lateral radiographs. Cage subsidence was classified using Marchi’s criteria. Results The mean follow-up duration was 6.3 ± 2.4 months. There were no significant differences among perioperative data (operation time, estimated intraoperative blood loss, and complication), clinical outcome (VAS, ODI, and JOA) and radiological outcome (SH and SL). The subsidence rate was 19.0% (4/21) in SA-OLIF group and 19.2% (5/26) in OLIF + LP group. 81.0% in SA-OLIF group and 80.8% in OLIF + LP group had Grade 0 subsidence, 14.3% in SA-OLIF group and 15.4% in OLIF + LP group had Grade I subsidence, and 4.8% in SA-OLIF group and 3.8% in OLIF + LP group had Grade II subsidence (P = 0.984). One patient with severe cage subsidence and lateral plate migration underwent revision surgery. Conclusions The additional lateral plate fixation does not appear to be more effective to prevent cage subsidence in the oblique lumbar interbody fusion, compared with stand-alone technique. If severe cage subsidence occurs, it may result in lateral plate migration in OLIF combined with lateral plate fixation.

Comparison of outcomes between indirect decompression of oblique lumbar interbody fusion and MIS-TLIF in one single-level lumbar spondylosis

Minimal invasive spinal fusion has become popular in the last decade. Oblique lumbar interbody fusion (OLIF) is a relatively new surgical technique and could avoid back muscle stripping and posterior complex destruction as in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Between December 2016 and September 2018, patients with single level degenerative spondylosis were selected to enroll in this retrospective study. A total of 21 patients that underwent OLIF and 41 patients that received MIS-TLIF were enrolled. OLIF showed significantly less blood loss and shorter surgery time compared to MIS-TLIF (p < 0.05). The improvement in segmental lordosis and coronal balance was significantly more in OLIF group than MIS-TLIF group (p < 0.05). When comparing with MIS-TLIF, OLIF was significantly better in Oswestry Disability Index (ODI) and visual analogue scale for back pain improvement at post-operative 6 months (p < 0.05). Both OLIF and MIS-TLIF are becoming mainstream procedures for lumbar degenerative-related disease, especially for spondylolisthesis. However, the indirect decompression of OLIF has shown to have less perioperative blood loss and shorter surgery time than that of MIS-TLIF. In addition, OLIF gives superior outcome in restoring segmental lordosis and coronal imbalance. While both OLIF and MIS-TLIF provide optimal clinical outcomes, upon comparison between the two techniques, the indirect decompression of OLIF seems to be a superior option in modern days.