Oblique Lateral Interbody Fusion Versus Minimally Invasive Transforaminal Lumbar Interbody Fusion for Lumbar Spinal Stenosis

Abstract

Objective: To evaluate postoperative improvements , complications, and reoperation rates between patients with lumbar spinal stenosis (LSS) undergoing oblique lateral interbody fusion (OLIF) or minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).Methods: We retrospectively studied 113 LLS patients who underwent OLIF or MIS-TLIF with percutaneous pedicle screw fixation between January 2016 and December 2018. We measured estimated blood loss, operative time, hospital stay, cost, reoperation, and complication incidence, visual analogue scale (VAS), Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA), and Short Form-36 (SF-36) scores, discal and foraminal height, lumbar lordotic angle, and fusion status (ClinicalTrials.gov number, NCT04778943). Results: OLIF was costlier than TLIF (p=0.001); however, the TLIF group had increased operation time, blood loss , and hospital stays (p=0.007, 0.001, and 0.016, respectively). Postoperatively, VAS and ODI scores significantly decreased while JOA and SF-36 scores significantly increased . The postoperative differences in main outcomes between the groups were insignificant (all p>0.05). The OLIF group had the lowest rates of overall (9.8% OLIF vs. 12.9% MIS-TLIF), intraoperative (3.9% OLIF vs. 4.8% MIS-TLIF), and postoperative complications (5.9% OLIF vs. 8.1% MIS-TLIF), but the differences were insignificant ( p =0.607, 0.813, and 0.653, respectively). The reoperation rate did not differ significantly (3.8% OLIF vs. 3.3% MIS-TLIF) (p =0.842). OLIF restored disc height (74.4% vs. 32.0%), foraminal height (27.4% vs. 18.2%), and lumbar lordotic angle (3.5% vs. 1.1%) with greater success than did MIS-TLIF. The fusion rate of the TLIF group (95.0%) was insignificantly lower than that of the OLIF group (98.1%, p =0.357). Conclusion: Patients undergoing OLIF with LSS improved similarly to MIS-TLIF patients. OLIF restored disc height, foraminal height, lumbar lordotic angle , and fusion rate more successfully than did MIS-TLIF. Clinical Trial: (ClinicalTrials.gov number, NCT04778943). Funding: This work was supported by grants from the National Natural Science Foundation of China (No. 81871818). Declaration of Interest: None to declare. Ethical Approval: This retrospective cohort study was conducted at Tangdu Hospital, Fourth Military Medical University. It was performed in accordance with the Declaration of Helsinki and approved by the hospital’s ethics committee.