Objective:

To compare the clinical and radiological effectiveness of oblique lumbar interbody fusion (OLIF) and posterior lumbar interbody fusion (PLIF) in the treatment of Cage dislodgement after lumbar surgery.

Methods:

The clinical data of 40 patients who underwent revision surgery due to Cage dislodgement after lumbar surgery betweem April 2013 and March 2017 were retrospectively analyzed. Among them, 18 patients underwent OLIF (OLIF group) and 22 patients underwent PLIF (PLIF group) for revision. There was no significant difference between the two groups in age, gender, body mass index, intervals between primary surgery and revision surgery, number of primary fused levels, disc spaces of Cage dislodgement, and visual analogue scale (VAS) scores of low back pain and leg pain, Oswestry disability index (ODI), the segmental lordosis (SL) and disc height (DH) of the disc space of Cage dislodgement, and the lumbar lordosis (LL) before revision ( P>0.05). The operation time, intraoperative blood loss, hospital stay, and complications of the two groups were recorded and compared. The VAS scores of low back pain and leg pain were evaluated at 3 days, 3, 6, and 12 months after operation, and the ODI scores were evaluated at 3, 6, and 12 months after operation. The SL and DH of the disc space of Cage dislodgement and LL were measured at 12 months after operation and compared with those before operation. CT examination was performed at 12 months after operation, and the fusion of the disc space implanted with new Cage was judged by Bridwell grading standard.

Results:

The intraoperative blood loss in the OLIF group was significantly less than that in the PLIF group ( t=-12.425, P=0.000); there was no significant difference between the two groups in the operation time and hospital stay ( P>0.05). Both groups were followed up 12-30 months, with an average of 18 months. In the OLIF group, 2 patients (11.1%) had thigh numbness and 1 patient (5.6%) had hip flexor weakness after operation; 2 patients (9.1%) in the PLIF group had intraoperative dural sac tear. The other patients’ incisions healed by first intention without early postoperative complications. There was no significant difference in the incidence of complications between the two groups ( χ ²=0.519, P=0.642). The VAS scores of low back pain and leg pain, and the ODI score of the two groups at each time point after operation were significantly improved when compared with those before operation ( P<0.05); there was no significant difference between the two groups at each time point after operation ( P>0.05). At 12 months after operation, SL, LL, and DH in the two groups were significantly increased when compared with preoperative ones ( P<0.05); SL and DH in the OLIF group were significantly improved when compared with those in the PLIF group ( P<0.05), and there was no significant difference in LL between the two groups ( P>0.05). CT examination at 12 months after operation showed that all the operated disc spaces achieved bony fusion. According to the Bridwell grading standard, 12 cases were grade Ⅰ and 6 cases were grade Ⅱ in the OLIF group, and 13 cases were grade Ⅰ and 9 cases were grade Ⅱ in the PLIF group; there was no significant difference between the two groups ( Z=-0.486, P=0.627). During follow-up, neither re-displacement or sinking of Cage, nor loosening or fracture of internal fixation occurred.

Conclusion:

OLIF and PLIF can achieve similar effectiveness in the treatment of Cage dislodgement after lumbar surgery. OLIF can further reduce intraoperative blood loss and restore the SL and DH of the disc space of Cage dislodgement better.

目的:

比较斜外侧腰椎间融合术（oblique lumbar interbody fusion，OLIF）及后路腰椎间融合术（posterior lumbar interbody fusion，PLIF）治疗腰椎术后椎间融合器（Cage）移位的临床及影像学效果。.

方法:

回顾分析 2013 年 4 月—2017 年 3 月因腰椎术后 Cage 移位进行翻修手术的 40 例患者临床资料，其中 18 例应用 OLIF 进行翻修（OLIF 组），22 例应用 PLIF 进行翻修（PLIF 组）。两组患者年龄、性别、体质量指数、初次手术至翻修手术间隔、初次融合节段数、Cage 移位椎间隙及术前腰腿痛疼痛视觉模拟评分（VAS）、Oswestry 功能障碍指数（ODI）、Cage 移位椎间隙的节段性前凸角（segmental lordosis，SL）、椎间隙高度（disc height，DH）以及腰椎前凸角（lumbar lordosis，LL）比较差异均无统计学意义（ P>0.05）。记录并比较两组手术时间、术中出血量、住院时间及并发症发生情况。术后 3 d 及 3、6、12 个月行腰腿痛 VAS 评分评价，术后 3、6、12 个月行 ODI 评分评价；术后 12 个月测量 Cage 移位椎间隙的 SL、DH 及 LL 并与术前比较；术后 12 个月行 CT 检查，采用 Bridwell 分级标准判断新植入 Cage 椎间隙融合情况。.

结果:

OLIF 组术中出血量明显少于 PLIF 组（ t=−12.425， P=0.000）；两组手术时间及住院时间比较差异无统计学意义（ P>0.05）。两组患者均获随访，随访时间 12～30 个月，平均 18 个月。OLIF 组 2 例（11.1%）术后出现大腿麻木，1 例（5.6%）出现屈髋无力；PLIF 组 2 例（9.1%）术中发生硬膜囊撕裂。其余患者切口均Ⅰ期愈合，无术后早期并发症发生。两组并发症发生率比较差异无统计学意义（ χ ²=0.519， P=0.642）。术后各时间点两组腰腿痛 VAS 评分、ODI 评分均较术前显著改善（ P<0.05）；术后各时间点两组间比较差异均无统计学意义（ P>0.05）。术后 12 个月两组 SL、LL、DH 均较术前显著增加（ P<0.05）；OLIF 组 SL 和 DH 显著大于 PLIF 组（ P<0.05），两组 LL 比较差异无统计学意义（ P>0.05）。术后 12 个月 CT 检查示手术椎间隙均骨性融合，按照 Bridwell 分级标准，OLIF 组Ⅰ级 12 例、Ⅱ级 6 例，PLIF 组Ⅰ级 13 例、Ⅱ级 9 例；两组差异无统计学意义（ Z=–0.486， P=0.627）。随访期间均未出现 Cage 再移位或下沉，内固定物松动、断裂现象。.

结论:

OLIF 及 PLIF 治疗腰椎术后 Cage 移位可获得相似的临床效果。OLIF 能进一步减少术中出血，更好地恢复 Cage 移位椎间隙 SL 及 DH。.