Application of Oblique Lateral Interbody Fusion in Treatment of Lumbar Spinal Tuberculosis in Adults

Abstract

The purpose of the present paper was to evaluate the safety and clinical efficacy of mini-open retroperitoneal oblique lumbar interbody fusion (OLIF) for the treatment of lumbar spinal tuberculosis.Methods: A total of 115 patients who suffered from lumbar spinal tuberculosis from June 2014 to December 2017 were included in this research. A total of 59 patients underwent OLIF and percutaneous pedicle screw fixation (OLIF group) and 56 patients underwent the anterior-only approach (anterior-only group). All patients were followed up for at least 24 months. Operation time, blood loss, and rate of complications were used to assess the safety of these two techniques. The visual analog scale (VAS) and the Oswestry disability index (ODI) were used to evaluate the relief of neurological and functional symptoms. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured to investigate the activity and recurrence of spinal tuberculosis. The Cobb angle, the sagittal vertical axis of the spine (SVA), the pelvic tilt (PT), the sacral slope (SS), the pelvic incidence (PI), and postoperative Frankel classification were also used to assess the efficiency of the spine deformity correction and the recovery of long-term neurological function.Results: Most patients were successfully treated with OLIF and the anterior-only technique and attained satisfactory clinical efficiency during the 24-month follow-up period. In the perioperative period, the mean operative time (154.68 AE 23.64 min, P < 0.001), the mean blood loss (110.57 AE 87.67 mL, P < 0.001), and the mean hospital stay (9.55 AE 3.62 days, P < 0.001) of the OLIF group were all significantly lower than in the anterioronly group (172.49 AE 25.67 min, 458.56 AE 114.89 mL, and 14.89 AE 3.89 days, respectively). A total of 10 patients (16.95%) experienced complications in the OLIF group, including neurological injury, segmental artery and iliac vein lacerations, peritoneal injury, instrument failure, and infection of incisions; this rate of complications was lower than in the anterior-only group (37.50%, P = 0.013). Regard to spinal deformity correction, the Cobb angle (9.42 AE 1.72 , P = 0.032), the SVA (2.23 AE 1.07 cm, P = 0.041), the PT (14.26 AE 2.37 , P = 0.037), and the SS (39.49 AE 2.17 , P = 0.042) of the OLIF group at last follow-up were all significantly different when compared to the anterior-only group (14.75

Pearls and Pitfalls of Oblique Lateral Interbody Fusion: A Comprehensive Narrative Review

“…The theoretical advantages of the antepsoas approach in the spinal infection treatment are as follows: (1) direct visualization and access to infectious tissue in the anterior column, allowing thorough debridement and stable anterior column reconstruction; (2) reduction of surgical morbidity when performed in a minimally invasive surgical (MIS) technique; and (3) avoidance of posterior spinal musculature violation during the posterior approach [ 55 ]. For these reasons, antepsoas lumbar interbody fusion combined with percutaneous pedicle screw fixation has shown superior clinical results, including infection control and complication rates, compared to other surgical techniques in previous studies [ 56 ].…”

One-stage freehand minimally invasive pedicle screw fixation combined with mini-access surgery through OLIF approach for the treatment of lumbar tuberculosis

“…When there is no psoas abscess, OLIF exposes the lesion of L1–5 by peeling psoas back to avoid damaging the nerves in psoas while open anterior-lateral surgery usually via iliopsoas may damage these nerves [ 5 ]. One-stage freehand MIPS combined with mini-access surgery through OLIF approach operated in a manner similar to traditional anterior combined posterior surgery, however, combined application of these two minimally invasive techniques had almost no damage to paraspinal muscles and no need to enter spinal canal [ 26 ]. The results in our study showed that patients receiving this surgery had less blood loss, shorter stay time in hospital, better pain relief and ODI during the follow-up than those receiving posterior open surgery.…”

Characteristics and hotspots of the 50 most cited articles in the field of pre-psoas oblique lumbar interbody fusion

“…Furthermore, according to a recent meta-analysis ( 27 ), OLIF effectively corrects sagittal and coronal deformities, in the absence of posterior columnar osteotomy, with a significant difference in VAS and ODI between the preoperative and postoperative periods. Furthermore, the OLIF procedure for treating single-level spinal tuberculosis is more effective than anterior surgery alone, with less trauma and a lower complication rate ( 28 ). This may be because the OLIF procedure allows for the direct and complete removal of infectious pathologies from the anterior column and anterior column reconstruction, while using a minimally invasive surgical technique that lowers surgical morbidity.…”