Yoshinao Koike, Yoshihisa Kotani, Hidemasa Terao, Yoshiaki Hosokawa, Hideyuki Kobayashi, Yusuke Kameda, Hideaki Fukaya

Transcription

1 Comparative Analysis of Physical Function and Quality of Life Parameters in Two Surgical Modalities for Single-level Degenerative Spondylolisthesis: OLIF with Percutaneous Posterior Fixation in Lateral Position versus MIS-TLIF. Yoshinao Koike, Yoshihisa Kotani, Hidemasa Terao, Yoshiaki Hosokawa, Hideyuki Kobayashi, Yusuke Kameda, Hideaki Fukaya STEEL MEMORIAL MURORAN HOSPITAL, MURORAN-SHI HOKKAIDO, Japan

2 Oblique lateral interbody fusion with percutaneous posterior fixation in lateral position (OLIF-LPF) l After performing OLIF procedure, percutaneous screws insertion are performed in the lateral position without position change under navigation guide l Posterior direct decompression is not performed

3 Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) l A single longitudinal midline incision is approximately 4cm l Bilateral paravertebral muscle is stripped and dissected to the inside of facet joint l Modified cortical bone trajectory (mcbt) screw technique is used Modified CBT : The starting point is at the caudal border of the pedicle, and the trajectory takes a caudocephalad directed path almost parallel to sagittal plane toward more anterior of the vertebral body than the original method.

4 Objective l To compare the physical function and quality of life (QOL) parameters between two MIS procedures: OLIF and MIS-TLIF for single-level DS OLIF-LPF MIS-TLIF

5 Methods l The database was retrospectively reviewed l Patients ü 92 patients of single-level DS who underwent the primary singlelevel minimally invasive lumbar interbody fusion surgery OLIF-LPF (Group O) N=42 MIS-TLIF (Group T) N=50 ü Mean follow-up Group O : 26.0 months (16-43) Group T : 42.1months (29-59) l Examination items ü Surgical time ü Estimated blood loss (EBL) ü C-reactive protein (CRP) level ü Visual Analogue Scale (VAS) ü Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ)

6 Comparison of background data Group O, N=42 Group T, N=50 P value Age (yr) 72.5± ± Sex male female DS level L3 L BMI (kg/m 2 ) 24.2± ± ASA score 2.0± ±

7 Results l Surgical invasiveness between groups O and T l VAS Group O, N=42 Group T, N=50 P value Surgical time (min) 110.8± ± EBL (ml) 52.5± ± CRP (mg/dl) preop 0.13± ± PO5d 2.28± ± ü The postoperative VAS scores revealed significant improvement compared with the preoperative values in all of the items in both groups VAS reduction Group O, N=42 Group T, N=50 P value Low back pain 31.3± ± Leg pain 40.6± ± Leg numbness 33.9± ±

8 Results l JOABPEQ Effective Rate (%) Group O, N=42 Group T, N=50 P value Low back pain Lumbar function Walking ability Social life Mental health <0.001

9 Summary of revision cases No. Age Sex Level of DS Primary surg. Reason for revision Revision surg M L4 L4-5 MIS-TLIF L4-5 Nonunion L4-5 OLIF 2 83 F L4 L4-5 MIS-TLIF L3-4 ASD L3-4 TLIF 3 76 M L3 L3-4 MIS-TLIF L2-3 ASD L2-3 OLIF 4 58 F L4 L4-5 MIS-TLIF L5-S1 ASD L5-S1 TLIF 5 71 F L4 L4-5 MIS-TLIF L5-S1 ASD L5-S1 TLIF 6 51 F L4 L4-5 OLIF-LPF L5-S1 ASD L5-S1 OLIF 7 67 M L4 L4-5 OLIF-LPF Screw deviation Screw replacement 8 80 F L4 L4-5 OLIF-LPF L3-4 ASD L3-4 OLIF 9 59 M L3 L3-4 OLIF-LPF L4-5 ASD L4-5 OLIF

10 Discussion l Invasiveness l VAS ü OLIF-LPF successfully shortened the operation time, which were equivalent to MIS-TLIF level ü CRP level 5 days after the operation in group O was equivalent to group T ü In both groups, the postoperative VAS scores revealed significant improvement compared with the preoperative values in all of the items ü No differences in the pre- and post-operative VAS score change were noted between two groups OLIF-LPF ü Less invasive surgery equivalent to MIS-TLIF ü Adequate indirect decompression of the neural elements brought excellent improvement of patient s pain

11 Discussion l JOABPEQ ü In both groups, the postoperative physical function parameters (Low back pain, Lumbar function, Walking ability) revealed improvement compared with the preoperative values ü In both groups, the postoperative QOL parameters (Social life, Mental health) revealed improvement compared with the preoperative values Effective rate in the psychological domain was significantly higher in group O than in group T ü OLIF-LPF improves physical function equal to MIS-TLIF ü OLIF-LPF have a large effect on patient s QOL

12 Conclusion l The physical function and QOL parameters between OLIF-LPF and MIS-TLIF for single-level DS were almost equivalent l There was the significant superiority of OLIF-LPF in terms of psychological domain l OLIF-LPF successfully shortened the operation time as well as minimizing the surgical invasiveness, which were equivalent to MIS- TLIF level