Comparative Clinical Analysis of Oblique Lateral Interbody Fusion with Percutaneous Posterior Fixation in Lateral Position versus MIS-TLIF with Modified Cortical Bone Trajectory Screws for Single-level Lumbar Degenerative Spondylolisthesis
Presented at SMISS Annual Forum 2016
By Yoshihisa Kotani MD, PhD
With Takuma Kaibara , Katsuhisa Fujita , Hideaki Fukaya , Toshiaki Kameda ,
Disclosures: Yoshihisa Kotani MD, PhD B; L&K Biomed. Takuma Kaibara None, Katsuhisa Fujita None, Hideaki Fukaya None, Toshiaki Kameda None,
The increased number of lateral access surgery has applied for various degenerative disorders. To date, there are mainly two options for the surgical treatment of lumbar degenerative spondylolisthesis: lateral access surgery versus
MIS-TLIF. There is still a paucity of comparative data regarding
the clinical results of these two approaches.
The objective of this study was to compare the clinical results of OLIF with percutaneous posterior fixation in lateral position versus MIS-TLIF with modified cortical bone screws (CBT) for single-level lumbar degenerative spondylolisthesis (DS).
A total of 70 patients were divided into following two groups: OLIF with percutaneous posterior fixation in lateral position in 20 patients (OLIF-LPF group) and MIS-TLIF with modified cortical bone screws in 50 patients (MIDLF group). There were no gender or age difference between two groups. The DS levels were limited to either L3 or L4 level. The OLIF-LPF group received a single-level OLIF followed by percutaneous posterior modified CBT fixation in lateral position. The MIDLF group received MIS-TLIF with PEEK cage and modified CBT with single 3.5cm midline incision. The surgical time, estimated blood loss, serum CRP and CK level at POD5, VAS, fusion rate, and complications were evaluated.
The operation time and EBL were 118min and 59.2ml versus 104min and 68.7ml in OLIF-LPF and MIDLF group, respectively (NS). CRP and CK levels were 1.9, 173 versus 2.4, 85.3, respectively (NS). The VAS in LBP and LE pain and numbness were significantly reduced at follow-up in both groups. Three cases in MIDLF groups required revision OLIF for pseudarthrosis, adjacent segment fusion and decompression. There were no pseudarthtrosis and revisions in OLIF-LPF group.
The OLIF with percutaneous modified CBT fixation successfully minimized the operation time without position change, which was equivalent to MIDLF. The EBL, CRP, and CK data demonstrated that OLIF-LPF and MIDLF were equally minimally invasive procedures. Although this initial average 17 months follow-up study did not showed the difference in LBP parameter, the patient-based questionnaire data analyses are still on going to further clarify the effect of two procedures on patients’ QOL in detail.