Comparing oblique lumbar interbody fusion with lateral screw fixation and percutaneous endoscopic transforaminal discectomy (OLIF-PETD) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for the treatment of lumbar disc herniation complicated with lumbar instability

Objective To evaluate the early clinical effect of oblique lumbar interbody fusion with lateral screw fixation and percutaneous endoscopic transforaminal discectomy (OLIF-PETD) in the treatment of lumbar disc herniation with lumbar instability. Methods A total of 22 patients with lumbar disc herniation and lumbar instability from August 2017 to August 2019 were enrolled in this retrospective study. The general information, perioperative indicators and complications were recorded. The clinical outcomes and radiological outcomes were evaluated before the operation, seven days after the operation, and at the last follow-up. Vertebral fusion and degree of multifidus muscle injury were evaluated at the last follow-up. Results In this study, OLIF + PETD showed shorter incision length compared to the MIS-TLIF ( P < 0.001). In the two groups, the clinical outcomes and radiological outcomes were significantly improved compared with the preoperative ( P < 0.001). At the seven days after the operation and the last follow-up, the VAS of OLIF + PETD group was lower than that of MIS-TLIF group ( P < 0.05). OLIF + PETD could give superior outcome in restoring disc height ( P < 0.001), but the fusion segment angle of OLIF + PETD group was larger compared to the MIS-TLIF group seven days after the operation and at the last follow-up ( P < 0.05). In addition, the fusion rate was not significantly different between the two groups ( P > 0.05), but OLIF + PETD could avoid the multifidus injury ( P < 0.001). Conclusion Compared to MIS-TLIF, OLIF-PETD can achieve satisfactory decompression effects and fusion rates with less multifidus injury and postoperative low back pain, which may be an alternative choice for the treatment of lumbar disc herniation combined with lumbar instability.