关键词: 腰椎滑脱症, 经椎间孔腰椎椎间融合术, 斜外侧腰椎椎间融合术, 后路椎弓根螺钉内固定, 退变性腰椎病, 围手术期评估

Abstract: Objective To evaluate the efficacy and safety of transforaminal lumbar interbody fusion (TLIF) and oblique lateral interbody fusion (OLIF) combined with posterior pedicle screw fixation in treating degenerative lumbar spondylolisthesis.MethodsThis retrospective analysis included 65 patients with degenerative lumbar spondylolisthesis treated at the Second Affiliated Hospital of Xi’an Medical University’s Department of Spine Surgery from January 2021 to February 2023.Patients were divided into two groups based on the surgical method:30 patients underwent OLIF combined with posterior pedicle screw fixation,and 35 patients underwent TLIF combined with posterior pedicle screw fixation.Perioperative outcomes (surgical time,intraoperative blood loss,etc.) were assessed,along with pre and post-operative evaluations using the Visual Analog Scale (VAS) for back pain,the Oswestry Disability Index (ODI),the Japanese Orthopaedic Association (JOA) score,the modified Macnab criteria,and radiological parameters (intervertebral disc height,foraminal height,lumbar lordosis angle,fusion segment lordosis angle,and vertebral slip rate).Results Both groups of patients completed a 6month follow-up.The intraoperative blood loss in the OLIF group was (57.79±11.54) ml,and the postoperative hospital stay was (5.85±0.94) days,while in the TLIF group,the values were (150.57±29.68) ml and (6.76±1.13) days,respectively.The differences between the two groups were statistically significant (P<0.05).The VAS score,ODI index,and JOA score on the 3rd postoperative day in the OLIF group were (1.50±0.61) points,(17.06±2.92)%,and (12.06±2.90) points,respectively,while in the TLIF group,they were (2.05±0.72) points,(26.41±3.38)%,and (10.24±2.68) points.The differences between the two groups were statistically significant (P<0.05).The intervertebral space height and foramen height on the 3rd postoperative day in the OLIF group were (14.43±1.50) mm and (23.87±1.41) mm,respectively,while in the TLIF group,they were (13.66±1.12) mm and (23.14±1.39) mm.The differences between the two groups were statistically significant (P<0.05).At 3 months postoperatively,the intervertebral space height and foramen height in the OLIF group were (13.42±1.41) mm and (23.34±1.33) mm,while in the TLIF group,they were (12.63±1.33) mm and (22.42±1.40) mm.The differences between the two groups were statistically significant (P<0.05).However,there were no statistically significant differences between the two groups in VAS score,ODI index,JOA score,modified Macnab criteria score,intervertebral space height,or foramen height at 6 months postoperatively (all P>0.05).From the 3rd postoperative day to 6 months,there were no statistically significant differences between the two groups in lumbar lordosis angle,segmental lordosis angle,or vertebral slippage rate (all P>0.05).Conclusion OLIF combined with posterior pedicle screw fixation may provide better short-term perioperative outcomes,particularly in terms of intraoperative blood loss and postoperative pain control,compared to TLIF.However,there were no significant differences in short-term outcomes between the two methods.

Key words: lumbar spondylolisthesis, transforaminal lumbar interbody fusion, oblique lateral interbody fusion, posterior pedicle screw fixation, degenerative lumbar disease, perioperative assessment