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Li Z, Wang X, Xie T, Pu X, Lin R, Wang L, Wang K, You X, Wu D, Huang S, Zeng J. Oblique lumbar interbody fusion combined with stress end plate augmentation and anterolateral screw fixation for degenerative lumbar spinal stenosis with osteoporosis: a matched-pair case-controlled study. Spine J 2023; 23:523-532. [PMID: 36539041 DOI: 10.1016/j.spinee.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/18/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND CONTEXT Oblique lumbar interbody fusion (OLIF) has been proven to be effective in treating degenerative lumbar spinal stenosis (DLSS). Whether OLIF is suitable for treating patients with DLSS with osteoporosis (OP) is still controversial. Bone cement augmentation is widely used to enhance the internal fixation strength of osteoporotic spines. However, the effectiveness of OLIF combined with bone cement stress end plate augmentation (SEA) and anterolateral screw fixation (AF) for DLSS with OP have not confirmed yet. PURPOSE To evaluate the clinical, radiological, and functional outcomes of OLIF-AF versus OLIF-AF-SEA in the treatment of DLSS with OP. STUDY DESIGN Retrospective case-control study. PATIENT SAMPLE A total of 60 patients with OP managed for DLSS at L4-L5. OUTCOME MEASURES Visual analog scale (VAS) score of the lower back and leg, Oswestry Disability Index (ODI), disk height (DH), lumbar lordosis (LL), segmental lordosis (SL), cage subsidence and fusion rate. METHODS The study was performed as a retrospective matched-pair case‒controlled study. Patients with OP managed for DLSS at L4-L5 between October 2017 and June 2020 and completed at least 2 years of follow-up were included, which were 30 patients treated by OLIF-AF and 30 patients undergoing OLIF-AF-SEA. The demographics and radiographic data, fusion status and functional outcomes were therefore compared to evaluate the efficacy of the two approaches. RESULTS Pain and disability improved similarly in both groups at the 24-month follow-up. However, the SEA group had lower pain and functional disability at 3 months postoperatively (p<.05). The mean postoperative disc height decrease (△DH) was significantly lower in the SEA group than in the control group (1.17±0.81 mm vs 2.89±2.03 mm; p<.001). There was no significant difference in lumbar lordosis (LL) or segmental lordosis (SL) between the groups preoperatively and 1 day postoperatively. However, a statistically significant difference was observed in SL and LL between the groups at 24 months postoperatively (p<.05). CS was observed in 4 cases (13.33%) in the SEA group and 17 cases (56.67%) in the control group (p<.001). A nonsignificant difference was observed in the fusion rate between the SEA and control groups (p=.347) at 24 months postoperatively. CONCLUSIONS This study revealed that OLIF-AF-SEA was safe and effective in the treatment of DLSS with OP. Compared with OLIF-AF, OLIF-AF-SEA results in a minor postoperative disc height decrease, a lower rate of CS, better sagittal balance, and no adverse effect on interbody fusion.
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Affiliation(s)
- Zhuhai Li
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Rd, Chengdu 610041, Sichuan, China; Department of Spine Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, No. 6 TaoYuan Rd, Nanning 530021, Guangxi, China
| | - Xiandi Wang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Rd, Chengdu 610041, Sichuan, China
| | - Tianhang Xie
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Rd, Chengdu 610041, Sichuan, China
| | - Xingxiao Pu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Rd, Chengdu 610041, Sichuan, China
| | - Run Lin
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Rd, Chengdu 610041, Sichuan, China
| | - Lihang Wang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Rd, Chengdu 610041, Sichuan, China; Department of Spine Surgery, Guizhou Provincial Orthopedics Hospital, No.206 Sixian Rd, Guiyang 550014, Guizhou, China
| | - Kai Wang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Rd, Chengdu 610041, Sichuan, China
| | - Xuanhe You
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Rd, Chengdu 610041, Sichuan, China
| | - Diwei Wu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Rd, Chengdu 610041, Sichuan, China
| | - Shishu Huang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Rd, Chengdu 610041, Sichuan, China.
| | - Jiancheng Zeng
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Rd, Chengdu 610041, Sichuan, China.
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