Comparative Clinical Analysis of OLIF51 and Percutaneous Posterior Fixation in Lateral Position vs MIS-TLIF for Lumbosacral Degenerative Disorders
Presented at SMISS Annual Forum 2018
By Yoshihisa Kotani MD, PhD
With J. Kim , H. Lee , M. Shin , S. Kim ,
Disclosures: Yoshihisa Kotani MD, PhD B; L&K Biomed. J. Kim None, H. Lee None, M. Shin None, S. Kim None,
Several advantages of lumbosacral ALIF have been reported in terms of superior stability, broad bone graft area, and indirect neural decompression. We have performed OLIF51 through retroperitoneal approach in lateral position, as well as simultaneous percutaneous posterior fixation for lumbosacral disorders. However, there have been a paucity of comparative data regarding OLIF51 versus conventional MIS-TLIF.
In this study, comparative clinical analysis between OLIF51 and MIS-TLIF was conducted for lumbosacral disorders.
A total of 56 patients underwent either OLIF51 (34 cases) or MIS-TLIF (22 cases). The average age was 62 yrs (27-81). The applied disorders were L5 isthmic spondylolisthesis, L4 degenerative spondylolisthesis and L5/S1 foraminal stenosis or DDD, and L5/S1 foraminal stenosis, and etc. The average fixed segment was 1.3 (1-3). The OLIF was used for L3/4 and L4/5 fusion procedures. Using 35 mm oblique incision, OLIF51 was performed through retroperitoneal approach under the visualization of left common iliac vein with enhanced O-arm 3D navigation. The simultaneous posterior percutaneous fixation was performed with modified CBT in same lateral position. MIS-TLIF was performed with midline 40 mm incision and modified CBT screws. The operation time, estimated blood loss, JOABPEQ effectiveness (%), VAS, bony fusion and complications were evaluated.
Average follow-up period was 19 and 31 months (12-45) in OLIF51 and MIS-TLIF, respectively. The average operation time per segment was 129 and 104 min, respectively. The estimated blood loss per segment was 65 and 79 ml, respectively. The JOABPEQ effective rate in OLIF51 demonstrated statistically higher value in LB function (48% vs 29%, P<0.01). The LBP VAS at F-up showed significant difference between OLIF51 and MIS-TLIF (22 vs 32; P<0.05). There were two pseudarthrosis in MIS-TLIF group (9%) and one required revision surgery with OLIF51. There were no vascular or neural complications in both groups.
Although MIS-TLIF has been reported as an excellent surgical procedure, there have been limitations in terms of fusion rate in severe osteoporosis and residual low back pain. This study showed higher fusion rate and less residual LBP in OLIF51 over MIS-TLIF. OLIF51 has advantages in no facet resection required and less paravertebral muscle injury, however, it is technically demanding. In our OLIF51, venous enhanced O-arm 3D image was successfully used to plan the accurate skin incision and surgical approach. The additional percutaneous posterior fixation in lateral position successfully avoided the position change with shorten operation time.