Percutaneous Delta Endoscopic Decompression versus Oblique Lateral Interbody Fusion for Lumbar Spinal Stenosis

Abstract

Background: Oblique lateral interbody fusion (OLIF) expands the inner volume of the spinal canal by indirect decompression. However, there were few studies to assess OLIF for LSS. The aim of this study was to evaluate outcomes and safety after percutaneous delta endoscopic decompression (PED) and OLIF. Methods: Ninety-four patients with lumbar spinal stenosis (LSS) underwent PED or OLIF with percutaneous pedicle screw fixation (PPS) between January 2016 and December 2018 were retrospectively studied. Patients were assessed by estimated blood loss (EBL), operative time, hospital stay, cost, reoperation, complications, the Visual Analogue Scale (VAS), the Oswestry Disability Index (ODI), Japanese Orthopaedic Association score (JOA) and Short Form-36 (SF-36). Results: Compared with OLIF group, the OLIF group was with longer operation time and hospital stay, more blood loss and more cost (p=0.001, 0.005, 0.001 and 0.001, respectively). Compared with preoperative data, VAS and ODI were significantly reduced and JOA and SF-36 increased significantly with the statistically significant difference (all p <0.05). There was no significant difference in postoperative main outcomes except VAS (lumbar) and ODI between the two groups (all p >0.05). But patients in the PED group were with lower VAS (lumbar) and ODI (p=0.012 and 0.042, respectively). In addition, the PED group was with SF-36 physical-component summary score (p=0. 0.036). The PED group was with lower all complication rate (2.4% PED vs 9.8% OLIF), intra-operative complication rate (2.4% PED vs 3.9% OLIF) and post-operative complication rate (0.0% PED vs 5.9% OLIF), but the difference was not statistically significant (p=0.336, 0.517 and 0.402, respectively). And there was no statistical difference in and reoperation rate (2.4% PED vs 3.8% OLIF) (p= 0.715).Conclusions: PED and OLIF had satisfactory results for LSS. In general, PED was superior to OLIF in relieving patients with low back pain and improving function without any obvious shortcomings. Therefore, we recommend PED for LSS.Level of Evidence: 3