Standalone oblique lateral interbody fusion vs. combined with percutaneous pedicle screw in spondylolisthesis

Abstract

Background: To compare standalone oblique lateral interbody fusion (OLIF) vs. OLIF combined with posterior bilateral percutaneous pedicle screw fixation (OLIF combined) for the treatment of lumbar spondylolisthesis.

Methods: This was a retrospective study of patients who underwent standalone OLIF or combined OLIF between 07/2014 and 08/2017 at two hospitals in China. Direct decompressions were not performed. Visual analog scale (VAS), Oswestry Disability Index (ODI), satisfaction rate, anterior/posterior disc heights (DH), foraminal height (FH), foraminal width (FW), cage subsidence, cage retropulsion, fusion rate, and complications were analyzed. All imaging examinations were read independently by two physicians and the mean measurements were used for analysis.

Results: A total of 73 patients were included: 32 with standalone OLIF and 41 with combined OLIF. The total complication rate was 25.0% with standalone OLIF and 26.8% with combined OLIF. There were no differences in VAS and ODI scores by 2 years of follow-up, but the scores were better with standalone OLIF at 1 week and 3 months (P < 0.05). PDH and FW was smaller in the combined OLIF group compared with the standalone OLIF group before and after surgery (all P < 0.05). There were significant differences in FH before surgery and at 1 week and 3 months between the two groups (all P < 0.05), but the difference disappeared by 2 years (P = 0.111). Cage subsidence occurred in 7.3% (3/41) and 7.3% (3/41) of the patients at 3 and 24 months, respectively, in the combined OLIF group, compared with 6.3% (2/32) and 15.6% (5/32), respectively, in the standalone OLIF group at the same time points (P = 0.287). There was no cage retropulsion in both groups at 2 years. The fusion rate was 85.4%(35/41) in the combined OLIF group and 84.4% (27/32) in the standalone OLIF group at 3 months(P = 0.669). At 24 months, the fusion rate was 100.0% in the combined OLIF group and 93.8% (30/32) in the standalone OLIF group (P = 0.066).

Conclusion: Standalone OLIF may achieve equivalent clinical and radiological outcomes than OLIF combined with fixation for spondylolisthesis. The rate of complications was similar between the two groups. Patients who are osteoporotic might be better undergoing combined rather than standalone OLIF. The possibilty of proof lies within a future prospective study, preferably an RCT.

Keywords: Oblique lumbar interbody fusion; Percutaneous pedicle screw fixation; Radiological outcomes; Spondylolisthesis.

Fig. 1

Radiological measurements (CT and X ray) used in this study. a Sagittal computed tomography (CT) image of lumbar vertebrae. The red line shows the foraminal height (FH). The yellow line shows the foraminal width (FW). b Sagittal CT image of lumbar vertebrae. The red line shows the anterior disc height (ADH), (c) Sagittal CT image of lumbar vertebrae. The red line shows the posterior disc height (PDH), (d) Lateral X-ray image of lumbar vertebrae. The red line shows the FW. e Lateral X-ray image of lumbar vertebrae. The red line shows the FH. f Lateral X-ray image of lumbar vertebrae. The red line shows the ADH. The yellow line shows the PDH

Fig. 2

Visual analogue scale of leg pain. Comparison between standalone oblique lateral interbody fusion (OLIF) and OLIF combined with pedicle screw fixation, from base line to 24 months after surgery

Fig. 3

Oswestry disability index. Comparison between standalone oblique lateral interbody fusion (OLIF) and OLIF combined with pedicle screw fixation, from base line to 24 months after surgery

Fig. 4

Intraoperative endplate damage. a White arrow: normal superior endplate of L5. Yellow arrow: the trial mold breaks in the vertebral body. b White arrow: normal superior endplate of L5. Yellow arrow: the trial mold breaks through the cortex of the endplate. c Yellow arrow: normal superior endplate of the vertebral body. Blue arrow: a cavity between the lower margin of the cage and the upper endplate of the vertebral body after the endplate is damaged and collapsed. The cavity was filled with DBM. White arrow: the cage

Fig. 5

Postoperative spine CT scan. There was potential translucency present at top and bottom of graft(L4/5 cage). There were vertebral compression fractures in both lower endplate and vertebral body of the L4 and upper endplate and vertebral body of the L5. The portion between the two white arrows is the transparent strip. The blue arrow indicates the normal cancellous bone manifestation of the vertebral body. The orange arrow indicates the “hardening”that occurs after a compressive fracture of the cancellous bone inside the vertebral body