Oblique Lumbar Interbody Fusion Combined with Posterior Percutaneous Pedicle Screw Internal Fixation: Does Variability in Cage Position Influence Clinical Outcomes?

Abstract

The study investigates how cage positions in oblique lumbar interbody fusion (OLIF) combined with posterior percutaneous pedicle screw internal fixation (PPSF) affect lumbar canal and foraminal decompression and postoperative outcomes, providing guidance for optimal placement and efficacy assessment. This investigation assesses radiological outcomes and follow-up data in relation to cage position variability among 80 patients who underwent L4/5 single-segment OLIF+PPSF from 2018-2022. In the study, involving 80 participants, the combination of OLIF and PPSF significantly improved lower back and leg symptoms in patients, leading to positive clinical outcomes during follow-up. The intervertebral DH increased from an average of 8.10 ± 2.79 mm before surgery to 11.75 ± 2.14 mm after surgery (P < 0.001). Additionally, this surgical technique notably increased the FH (P < 0.001) and expanded the DCSA from 68.81 ± 53.89 mmˆ2 before surgery to 102.91 ± 60.46 mmˆ2 after surgery (P < 0.001). Linear results suggest that changes in the position of the cage do not affect spinal imaging parameters. There is no significant difference in the correction of spinal parameters or prognosis whether the cage is back, middle, ahead. In the OLIF+PPSF procedure, strict requirements for cage position are not necessary to achieve predetermined spinal biomechanical parameters. The practice of repeated fluoroscopy to adjust cage position post-implantation does not provide added clinical benefits to the patient.