Comparison of navigation-assisted single position oblique lumbar interbody fusion and minimally invasive surgical transforaminal lumbar interbody fusion in L4 degenerative lumbar spondylolisthesis: A retrospective analysis

Abstract Background: Minimally invasive surgical oblique lumbar interbody fusion (MIS-OLIF) is an innovative anterolateral, retroperitoneal, and anterior psoas approach for L4 degenerative lumbar spondylolisthesis (DLS). A single-position technique and the utilize of the navigation system improves surgical outcomes. Methods: This study retrospectively analyzed successive patients treated with navigation-assisted single position oblique lumbar interbody fusion (NASP-OLIF) or minimally invasive surgical transforaminal lumbar interbody fusion (MIS-TLIF) for L4 DLS. According to the surgical procedures, participants were divided into NASP-OLIF and MIS-TLIF groups. Operative duration times, intraoperative blood loss, postoperative first floor activity time, total screw placement time, per screw time, cage height, visual analog scale (VAS), Oswestry disability index (ODI), slipping distance (SD), segmental lordosis (SL), intervertebral foraminal area (IFA), intervertebral disc height (IDH), and spinal canal cross-sectional area(CSA) were compared between groups. Results: Among 53 patients (NASP-OLIF: 25 vs MIS-TLIF: 28) treated for L4 DLS between September 2017 and June 2020. There were 212 pedicle screws insertion (NASP-OLIF: 100 vs MIS-TLIF: 112). In the NASP-OLIF group, according to the Gertzbein-Robbins scale, screws were as follow: grade A with 90 screws, grade B with 6 screws, grade C with 3 screws, grade D with 1 screw, Grade E with no screw.There were no neurovascular injury. The satisfactory rate of screw insertion was 96%. The NASP-OLIF group showed significantly shorter the operative duration times, lessened intraoperative blood loss, higher cage height and shorter postoperative first floor activity time, and shorter total screw and per-screw placement times (P<0.05). On postoperative and last follow-ups,IDH and IFA were significantly improved in the NASP-OLIF group (P<0.05); VAS of leg pain (VASL), VAS of low back pain (VASB), and ODI were significantly decreased in the NASP-OLIF group (P<0.05). SL, SD, or CSA was no remarkably differences between groups (P>0.05). Conclusions: NASP-OLIF was superior to MIS-TLIF in the aspect of the reduction of trauma and faster recovery. However, the two surgical techniques were comparable in many other aspects.