The clinical and radiographic resuls of oblique lateral internal fusion combined with percutaneous pedicle screw fixation in the treatment of severe lumbar spinal stenosis

Abstract

Backgrounds Oblique lumbar interbody fusion (OLIF) has been a popular technique for the treatment of lumbar degenerative diseases. Previous studies have shown its efficiency in lumbar spinal stenosis. But few studies have reported its application of severe lumbar spinal stenosis. The purpose the of study is to investigate the clinical and radiographic outcome of OLIF with percutaneous pedicle screws in the treatment of severe lumbar spinal stenosis. Methods Fifteen patients who underwent OLIF with percutaneous pedicle screws were retrospectively analyzed. All patients were diagnosed as severe lumbar stenosis (Schizas grade C or D) through preoperative magnetic resonance image and recieved OLIF combined with percutaneous pedicle screws surgery. Clinical outcomes including visual analogue scale (VAS)-back and and VAS-leg scores and Oswestry disability index (ODI) were evaluated before surgery and at last follow-up. Mean disc height (DH), mean foraminal height (FH), segmental lumbar lordosis (SLL) and cross-sectional area (CSA) of spinal canal were compared before and after surgery and at the last follow-up. Intraoperative data, complications and fusion rate were also investigated. Results OLIF combined with percutaneous pedicle screws was performed in 18 segments in 15 patients. Mean follow-up was 23.1 ± 4.6 months (range, 12–34 months). VAS-back, VAS-leg, and ODI scores were significantly better at last follow-up. DH increased from 8.86 ± 3.06 mm before surgery to 13.31 ± 2.14 mm after; at last follow-up, DH was 11.69 ± 1.87 mm. FH increased from 17.85 ± 2.26 mm before surgery to 22.09 ± 1.36 mm after; at last follow-up, FH was 20.41 ± 0.99 mm. CSA of spinal canal increased from 30.83 ± 21.15 mm2 before surgery to 74.99 ± 33.65 mm2 after operation and 81.22 ± 35.53 mm2 at last follow-up. The segmental LL before surgery, after surgery and at last follow-up were 20.27 ± 6.25 degrees, 20.83 ± 6.52 degrees and 19.75 ± 5.87 degrees, respectively. All patients have gained fusion at last follow-up. Conclusions OLIF with percutaneous pedicle screws could achieve satisfactory clinical and radiographic effect through indirect compression by increasing DH, FH and CSA of spinal canal, and it could be regarded as an appropriate approach for severe lumbar stenosis patients.